Infant with left postauricular swelling

CT of Bezold abscess and coalescent mastoiditis — Axial CT with contrast of the brain (above left) shows two rim enhancing fluid collections in the subcutaneous tissues next to the left mastoid air cells. There is also extensive soft tissue inflammation tracking up the left side of the skull (above right). Axial CT bone windows (below) shows complete opacification of the left mastoid air cells and bone erosion and destruction along the lateral wall of the mastoid bone that is allowing communication between the mastoid air cells and the largest rim enhancing fluid collection.

The diagnosis was Bezold abscess in a patient with coalescent mastoiditis.

Infant with head trauma after motor vehicle accident

CT of atypical teratoid rhabdoid tumor — Axial (above), coronal (below left) and sagittal (below right) CT without contrast of the brain show an oval high density solid mass centered in the region of the pineal gland.

The diagnosis was atypical teratoid rhabdoid tumor.

Toddler with a hair tuft at the cranial vertex

MRI of atretic cephalocele — Sagittal T2 MRI of the brain shows in the subcutaneous tissue at the vertex of the skull a subgaleal lipomatous and cystic lesion in close approximation to a persistent falcine sinus.

The diagnosis was atretic cephalocele.

School ager with Trisomy 21 being cleared for general anesthesia

Radiograph of atlanto occipital instability — Lateral flexion view of the cervical spine (left) shows a normal relationship of the occipital condyles to the articular facets of the atlas. The atlanto dental interval is also normal. Lateral extension view of the cervical spine (right) shows posterior displacement of the occipital condyles in relation to the articular facets of the atlas. There is posterior positioning of Wackenheim line and retrolisthesis of the C3 on C4 vertebral body. The atlanto dental interval remains normal.

The diagnosis was atlanto occipital instability in a patient with Trisomy 21.

Teenager after motor vehicle accident

CT of Type 2 fracture of the odontoid process of the C2 vertebral body and atlanto-occipital dissociation — Midline sagittal CT without contrast of the cervical spine (middle) shows a transverse comminuted fragmented fracture through the C2 vertebral body. There is anterior displacement of the C1 vertebral body resulting in compromise of the spinal canal. There is massive thickening of the retropharyngeal soft tissues due to a retropharyngeal hematoma. The basion-dens interval is abnormally increased. The off midline sagittal CTs (left and right) show distraction between the occipital condyles bilaterally and the C1 articular facets.

The diagnosis was a Type 2 fracture of the odontoid process of the C2 vertebral body and atlanto-occipital dissociation.

School ager with Ehler Danlos syndrome being cleared for general anesthesia

Flexion and extension radiographs of atlanto axial instability — Lateral radiograph of the cervical spine in extension (left) shows the atlanto dental interval to measure 0 mm. Lateral radiograph of the cervical spine in flexion (right) shows the atlanto dental interval to measure 7 mm.

The diagnosis was atlanto axial instability in a patient with Ehlers Danlos syndrome.

Preschooler with an occipital skull fracture after trauma

CT venogram of arachnoid granulations — Axial CT venogram of the brain (left) shows a single smooth round filling defect in each transverse sinus laterally, left larger than right. Coronal CT (right) again shows the filling defect in the left transverse sinus

The diagnosis was arachnoid granulations in the transverse sinuses.

Preschooler with developmental delay

MRI of arachnoid cyst of the posterior fossa — Axial (above left), coronal (above right) and sagittal (below) T2 MRI of the brain show a midline to right of midline high signal intensity lesion in the posterior fossa which is inferior to an intact cerebellar vermis and the right cerebellar hemisphere and which is having mass effect on the cerebellum.

The diagnosis was arachnoid cyst of the posterior fossa.

Newborn with a skin defect and a bump on the skull

MRI of aplasia cutis — Axial T1 MRI without contrast (above left) and axial T2 (above right) of the brain show an oval lesion in the subcutaneous tissue which is isointense on T1WI and hyperintense on T2WI. Coronal T1 MRI without contrast (below) show a bone defect in the skull beneath the cystic lesion.

The diagnosis was aplasia cutis.

Teenager with nasal stuffiness

CT of antochoanal polyp — Axial CT with contrast of the face (left) shows a low-density left-sided polyp originating in and filling the left maxillary sinus which extends medially to the nasal cavity and which on the sagittal CT (right) is then seen to continue to extend inferiorly into the posterior nasopharynx and oropharynx.

The diagnosis was antrochoanal polyp.

Teenager with gradual onset of gait disturbance

MRI of pediatric cervical spine disc herniation causing cord compression — Sequential sagittal T2 MRI of the spine shows at the level of C5-C6 low signal intensity material herniating posteriorly causing severe stenosis of the spinal canal along with bright signal in the spinal cord at that level.

The diagnosis was disc herniation of the C5-C6 intervertebral disc causing severe spinal canal stenosis and edema of the spinal cord.

School ager with headaches

CT of thrombosed pediatric basilar artery aneurysm — Axial (above left), sagittal (above right) and coronal (below) CT without contrast of the brain show a circular high density lesion posterior to the clivus that is in the course of the basilar artery.

The diagnosis was a thrombosed intracranial aneurysm of the basilar artery.

Teenager with sore throat for 1 week who is now having difficulty breathing

CT of pediatric peritonsillar abscess — Axial (left) and coronal (right) CT with contrast of the head and neck show a round mass with a low density center and a thick enhancing rim that is lateral to the left palatine tonsil and which is causing mass effect on the airway.

The diagnosis was left peritonsillar abscess.

Teenager with fever and odynophagia

CT of intratonsillar abscess of right palatine tonsil — Axial (left), coronal (above right) and sagittal (below right) CT with contrast of the head and neck show a low density fluid collection in the right palatine tonsil that is surrounded by a thin enhancing rim of tissue. The airway is widely patent.

The diagnosis was intratonsillar abscess of the right palatine tonsil.

School ager with a ventriculoperitoneal shunt and a new headache

Radiograph of broken ventriculoperitoneal shunt tubing — AP radiograph of the skull (left) shows a break in the VP shunt tubing just above the right orbit. AXR (right) shows the remaining VP shunt tubing coiled in the pelvis.

The diagnosis was ventriculoperitoneal shunt malfunction in the form of broken shunt tubing.

Infant whose anterior fontanelle appeared to close prematurely

Radiograph and CT of Wormian bone in the anterior fontanelle — AP radiograph of the skull (left) shows a bone in the region of the anterior fontanelle. 3D CT without contrast of the skull (right) shows a Wormian bone in the anterior fontanelle.

The diagnosis was Wormian bones with a Wormian bone in the anterior fontanelle.

Teenager with a VP shunt with a new headache

Radiograph of broken VP shunt tubing — AP radiograph of the neck (above) shows the VP shunt catheter is broken at the level of the mid-neck. Axial CT without contrast of the brain obtained one year ago (below left) shows the tip of the VP shunt in the left lateral ventricle and the ventricular system to be decompressed. Current axial CT without contrast (below right) shows the tip of the VP shunt to be in the left lateral ventricle and interval development of dilation of the ventricular system.

The diagnosis was ventriculoperitoneal shunt malfunction in the form of broken shunt tubing causing interval development of hydrocephalus.

Teenager with abdominal pain

MRI of schwannoma — AXR AP (above left) shows an incidental semi-circular left paraspinal mass next to the T10-T11 vertebral bodies. Axial T1 MRI without contrast of the thoracic spine (below left) shows an isointense round mass just to the left of the vertebral body. On axial T2 MRI (below center) the mass is hyperintense and on axial T1 MRI with contrast (below right) the mass enhances avidly and homogeneously. There was no spinal extension of the mass. On coronal T1 MRI with contrast (above right) the mass is again seen to be next to the T10-T11 vertebral bodies.

The diagnosis was schwannoma.

Preschooler 1 year after medical and surgical treatment for a posterior fossa tumor

MRI of spinal drop metastases in medulloblastoma — Sagittal (left and middle) T1 MRI with contrast of the spine shows diffuse enhancement along the cerebellar folia and the anterior and posterior aspects of the entire spinal cord. Axial T1 MRI with contrast of the spine (right) shows the enhancement to be somewhat nodular in nature around the spinal cord.

The diagnosis was recurrent medulloblastoma resulting in drop metastases to the spinal cord.

Newborn with respiratory distress

US of intracerebral hemorrhage due to extracorporeal membrane oxygenation — CXR AP (above) shows the tip of the nasogastric tube in the left hemithorax. The punctate radiopaque tip of the arterial ECMO catheter projects near the aortic arch. The punctate radiopaque tip of the venous ECMO catheter projects in the right atrium. The endotracheal tube tip projects between the clavicles and the carina.

Coronal (below left) and sagittal (below right) US of the brain shows a round well-circumscribed echogenic lesion adjacent and inferior to the posterior horn of the right lateral ventricle.

The diagnosis was intracerebral hemorrhage as a complication of extracorporeal membrane oxygenation in a patient with a left-sided congenital diaphragmatic hernia.

Newborn with a seizure

MRI of Lhermitte-Duclos disease — Sagittal (above left), axial (above right) and coronal (below left) T1 MRI without contrast of the brain shows a round lesion centered in the vermis of the cerebellum that is displacing the fourth ventricle to the left. The lesion has hypointense thickened cerebellar folia giving it a striated appearance. The cerebellar folia are hyperintense on the axial T2 MRI (below). The lesion did not enhance.

The diagnosis was Lhermitte-Duclos disease.

School ager with neck pain after motor vehicle accident

CT and MRI of a cervical spine fracture through the left synchondrosis of the C1 vertebral body. — Axial (above left) and coronal (above right) CT without contrast of the cervical spine shows a relative slight diastasis of the left synchrondrosis of the C1 vertebral body when compared to the right synchondrosis. Axial T2 MRI without contrast of the cervical spine shows bright signal in the left synchrondosis (below left) of the C1 vertebral body and anterior to the left synchondrosis (below right).

The diagnosis was fracture of the cervical spine through the left synchondrosis of the C1 vertebral body.

Newborn with a brain cyst on prenatal ultrasound

MRI of intraventricular simple cyst — Axial (above left) and coronal (above right) T2 MRI and sagittal T1 MRI without contrast (below) of the brain show a thin walled round structure without septations in the posterior horn of the right lateral ventricle that follows cerebrospinal fluid signal characteristics on all MRI sequences.

The diagnosis was intraventricular simple cyst.

Newborn who has been abused

Radiograph and CT of Hangman cervical spine fracture — Lateral radiograph of the cervical spine (left) shows a large amount of prevertebral soft tissue swelling. There are fractures through the bilateral pedicles of the C2 vertebral body resulting in anterior translation of the C2 vertebral body on the C3 vertebral body. Sagittal CT without contrast of the cervical spine through the left (above center) and right (above right) pedicles better demonstrates the fractures through them as does the axial CT through the C2 vertebral body (below right).

The diagnosis was Hangman cervical spine fracture due to child abuse.

School ager with acute back pain and gait instability

MRI of myxopapillary ependymoma of the spinal cord — Sagittal T1 MRI without contrast (left), T2 MRI (center), and T1 MRI with contrast (right) of the lumbar spine shows an intradural extramedullary cylindrical solid mass that is arising from the filum terminale and which shows minimal enhancement. On T2 MRI (center) the mass has a triangular area of low signal intensity along its superior border (cap sign).

The diagnosis was a myxopapillary ependymoma of the spinal cord.