School ager with juvenile idiopathic arthritis with neck pain and torticollis for 6 weeks

CT of atlanto-axial rotatory subluxation due to juvenile idiopathic arthritis — Axial images from a CT without contrast of the cervical spine shows the C1 vertebral body rotated to the left approximately 45 degrees (top) in relation to the C2 vertebral body (middle). A MIP image (bottom) better demonstrates the rotation of C1 on C2.

The diagnosis was atlanto-axial rotatory subluxation due to juvenile idiopathic arthritis.

Preschooler with fever and torticollis

CT of atlanto-axial rotatory subluxation due to retropharyngeal abscess — Axial images with bone windows from a CT with contrast of the neck shows the C1 vertebral body (above left) rotated approximately 30 degrees to the right in relation to the C2 vertebral body (above right). Axial image with soft tissue windows (below) from the same CT shows a low density fluid collection with an enhancing rim to the left of midline in the retropharyngeal space.

The diagnosis was atlanto-axial rotatory subluxation due to a retropharyngeal abscess.

Preschooler who developed torticollis after watching a video on their tablet with their neck flexed for 8 hours without moving

CT of atlanto-axial rotatory subluxation — 3D CT without contrast of the cervical spine shows the C1 vertebral body rotated to the left approximately 30 degrees in relation to the C2 vertebral body.

The diagnosis was atlanto-axial rotatory subluxation due to muscle spasm.

Infant with torticollis since birth and a left neck mass

US of fibromatosis coli — Transverse US of the neck shows a normal sized hypoechoic right sternocleidomastoid muscle lying above the jugular vein and carotid artery. The left sternocleidomastoid muscle has a heterogenous echotexture and is 5-6 times larger in size than the right.

The diagnosis was fibromatosis colli.

Infant with torticollis since birth and a right neck mass

US of fibromatosis coli — Transverse US of the neck shows a normal sized hyopechoic left sternocleidomastoid muscle lying above the jugular vein and carotid artery. The right sternocleidomastoid muscle is more heterogenous in echotexture and is 3-4 times larger in size than the left.

The diagnosis was fibromatosis colli.

Infant with torticollis since birth

CT of atlanto-axial rotatory subluxation — Axial CT without contrast of the cervical spine shows the C1 vertebral body rotated to the left approximately 45 degrees in relation to the C2 vertebral body.

The diagnosis was atlanto-axial rotatory subluxation without a demonstrated etiology.

School ager with torticollis since birth

Radiograph of Klippel-Feil syndrome — AP radiograph of the cervical spine shows multiple segmentation anomalies including vertebral body fusion and hemivertebrae of the cervical spine and upper thoracic spine.

The diagnosis was Klippel-Feil syndrome.

Newborn with inability to pass a nasogastric tube through either nares

CT of choanal atresia — Axial CT without contrast of the face shows thickening and bowing of the vomer bilaterally resulting in narrow choana bilaterally.

The diagnosis was choanal atresia.

Newborn with inability to pass nasogastric tube through the nose

CT of pyriform aperture stenosis — Axial CT without contrast of the face shows narrowing of the pyriform apertures bilaterally.

The diagnosis was pyriform aperture stenosis.

School ager with large soft tissue masses involving the right arm and chest

Clinical image of neurofibromatosis type 1 with chest wall and arm plexiform neurofibromas — Clinical image shows extensive, large soft tissue masses involving the right arm and chest wall.

The diagnosis was Neurofibromatosis type 1 with multiple plexiform neurofibromas of the right arm and chest wall.

School ager with a rapidly enlarging soft tissue mass of the right chest and arm

CXR and CT of malignant peripheral nerve sheath tumor in neurofibromatosis type 1 — CXR PA and lateral shows a right apical thoracic mass with associated rib thinning that had rapidly increased in size in a short interval. Axial CT without contrast of the chest better defined the right apical mass and demonstrated multiple serpiginous nodules in the soft tissues of the right anterior chest wall.

The diagnosis was degeneration of a plexiform neurofibroma into a malignant peripheral nerve sheath tumor in a patient with neurofibromatosis type 1.

School ager with cafe-au-lait spots

CXR and CT of plexiform neurofibroma in neurofibromatois type 1 — CXR PA shows a large soft tissue mass in the apex of the right lung which causes thinning of the right 1st-5th ribs posteriorly. CT without contrast of the chest shows multiple small nodules throughout the soft tissues of the chest wall.

The diagnosis was multiple plexiform neurofibromas in a patient with neurofibromatosis type 1.

Infant after cardiac surgery on ECMO

CT of cerebellar hemorrhage on extracorporeal membrane oxygenation (ECMO) — Axial and coronal CT without contrast of the brain shows three round mixed density lesions in the cerebellum compressing the fourth ventricle and causing hydrocephalus. The fluid-fluid levels in the lesions were felt to represent active bleeding.

The diagnosis was cerebellar hemorrhage on ECMO.

Infant with congenital heart disease on ECMO

CT of intracerebral hemorrhage in a patient on extracorporeal membrane oxygenation (ECMO) — Sagittal, coronal and axial CT without contrast of the brain shows a large, round high density lesion in the right parietal lobe.

The diagnosis was intracerebral hemorrhage on ECMO.

Newborn with congenital diaphragmatic hernia on ECMO

US of intracerebral hemorrhage in a patient on extracorporeal membrane oxygenation (ECMO) — Coronal and sagittal US of the brain shows a large, round echogenic lesion in the left parietal lobe.

The diagnosis was intracerebral hemorrhage on ECMO.

Infant who was on arterial-venous ECMO post cardiac arrest and has just been taken off of ECMO

CT of intraventricular hemorrhage, intracerebral hemorrhage, and cerebral atrophy in a patient on extracorporeal membrane oxygenation (ECMO) — Axial CT without contrast of the brain shows mixed-density fluid in the left lateral ventricle posteriorly and mixed-density fluid in the left parietal-occipital lobe. There is also diffuse prominence of the sulci and ventricular system.

The diagnosis was intraventricular hemorrhage on ECMO and intracerebral hemorrhage on ECMO and cerebral atrophy post ECMO.

Newborn who is on ECMO after cardiac surgery

US of subdural hematoma and intracerebral hemorrhage in patient on extracorporeal membrane oxygenation (ECMO) — Coronal US of the brain (below) shows echogenic material in right subdural space. Coronal and sagittal US of the brain (above) shows a right parietal round mixed echogenicity lesion.

The diagnosis was subdural hematoma on ECMO and intracerebral hemorrhage on ECMO.

Infant with congenital heart disease who was on ECMO a month ago

CT of cerebral atrophy after being on extracorporeal membrane oxygenation (ECMO) — Axial CT without contrast of the brain shows diffuse prominence of the sulci and ventricular system.

The diagnosis was cerebral atrophy post ECMO.

Newborn who did not receive a screening head ultrasound before being placed emergently on ECMO and who is not doing well on ECMO

US of Vein of Galen malformation — Coronal and sagittal US of the brain shows a high flow vascular structure in the region of the median prosencephalic vein. A bruit was subsequently noted in this area.

The diagnosis was Vein of Galen malformation, which is a contraindication to being placed on ECMO.

Infant with a new right scrotal bulge

AXR and US of ventriculoperitoneal shunt tip in the scrotum — AXR (above) shows the tip of the VP shunt has migrated into the right scrotum. Transverse US image (below) shows a moderate left hydrocele and the round VP shunt catheter in the medial aspect of the right scrotum.

The diagnosis was migration of the VP shunt catheter tip through the right inguinal canal into the right scrotum.

Newborn with a prenatal diagnosis of hydrocephalus, status post VP shunt placement

CT of over-shunting — Initial axial CT without contrast of the brain (above) showed marked dilation of the lateral, third and fourth ventricles. Axial CT without contrast of the brain 1 day after shunt placement (below) shows interval decompression of the ventricular system and interval development of large bilateral subdural hygromas.

The diagnosis was subdural hygroma development due to over-shunting.

Infant with increasing abdominal distension over 4 days

CT of CSFoma — Axial CT with intravenous and oral contrast of the abdomen shows an extremely large mass filling the abdomen with the tip of the VP shunt within it which is causing hydronephrosis and displacement of the bowel.

The diagnosis was VP shunt malfunction due to a CSFoma.

Preschooler status post VP shunt replacement 1 hour ago

CT of ventriculoperitoneal shunt malfunction — Axial CT without contrast of the brain obtained postoperatively shows a VP shunt catheter placed from a right parietal approach whose tip lies within the brain parenchyma.

The diagnosis was VP shunt malfunction due to malposition of the shunt tip within the brain parenchyma.

Preschooler with a new palpable prominence over the region of the VP shunt in the neck

Radiograph of ventriculoperitoneal shunt malfunction — AP and lateral radiographs of the skull and an AP radiograph of the abdomen shows a discontinuity between the reservoir of the VP shunt in the neck and the remainder of the VP shunt in the abdomen.

The diagnosis was VP shunt malfunction due to shunt discontinuity.

Newborn with myelomeningocele with fever who is status post recent VP shunt placement and whose CSF is positive for infection

CT of ventriculitis — Axial CT with contrast of the brain shows subependymal enhancement throughout the ventricular system.

The diagnosis was an infected VP shunt with ventriculitis.