Preschooler with seizures

MRI of optic pathway gliomas in neurofibromatosis type I — Axial (left) and coronal T1 MRI with contrast of the orbits shows marked thickening of the optic nerves bilaterally.

The diagnosis was bilateral optic pathway gliomas in a patient with neurofibromatosis type I.

Preschooler with cafe au lait spots

MRA of Moya Moya syndrome in neurofibromatosis type I — AP view of a 3D maximum intensity projection of an MRA of the neck with contrast (above) and AP (below left) and inferior (below right) views of a 3D maximum intensity projection of an MRA of the brain without contrast shows diffuse hypoplasia of the left internal carotid artery. There is stenosis and occlusion of the cavernous and supraclinoid segments of the left internal carotid artery and then there is a thin left M1 segment without evidence of collaterals in the basal ganglia. Additionally, aneurysms are noted in the left A1 and A2 segments.

The diagnosis was Moya Moya syndrome in a patient with neurofibromatosis type I.

Newborn who was dropped on the floor in the delivery room

CT of skull molding — Axial (left) and coronal (right) CT without contrast of the brain show the occiptal bone of the skull to be pushed underneath the parietal bones of the scalp. No skull fractures are seen.

The diagnosis was skull molding.

Infant who had a forceps delivery 3 months ago

Radiograph of calcified cephalohematoma — AP radiograph of the skull shows bilateral calcified cresenteric areas in the subcutaneous tissues on the top of the skull that do not cross suture lines.

The diagnosis was bilateral calcified cephalohematomas.

Newborn with failure to progress during delivery due to dystocia who is now apneic

CT of caput succedaneum — Axial CT without contrast of the brain shows a cresenteric high-density fluid collection in the subcutaneous tissues of the right scalp that crosses suture lines and a cresenteric low-density fluid collection in the subcutaneous tissues of the left scalp that crosses suture lines. Intracranially, there is diffuse loss of gray matter-white matter differentiation secondary to diffuse cerebral edema.

The diagnosis was a left caput succedaneum and a right subgaleal hematoma in a patient with hypoxic ischemic encephalopathy.

Newborn who experienced prolonged labor

CT of caput succedaneum — Axial (above), coronal (below left) and sagittal (below right) CT without contrast of the brain show a large low density fluid collection in the subcutaneous tissues of the scalp that crosses sutures and is seen to surround the skull on the coronal view. Intracranially, there is diffuse loss of gray matter-white matter differentiation secondary to diffuse cerebral edema.

The diagnosis was caput succedaneum in a patient with hypoxic ischemic encephalopathy.

Infant with a flat spot on the back of the head

Radiograph of positional plagiocephaly — AP (left) and lateral (right) radiographs of the skull show the bilateral coronal sutures and lambdoid sutures and sagittal suture to be patent. There is some mild flattening along the posterior aspect of the skull

The diagnosis was positional plagiocephaly.

Infant with a palpable ridge on the top of the head

Radiograph and 3D CT of sagittal craniosynostosis — AP (above left) and lateral (above right) radiographs of the skull show the skull to be lengthened (scaphocephaly / dolichocephaly). The sagittal suture appears sclerotic. Superior (below left) and lateral (below right) 3D CT reconstructions of the skull show the skull to be lengthened and complete fusion of the sagittal suture. The remaining sutures are patent.

The diagnosis was sagittal craniosynostosis.

Infant with a bump on the forehead

3D CT of metopic craniosynostosis — Axial CT without contrast of the brain (left) shows fusion of the metopic suture in the midline and a triangular appearance to the anterior aspect of the skull (trigonocephaly). Anterior 3D CT reconstruction (right) shows a prominent midline ridge in the anterior skull and hypotelorism with quizzical eye deformities present bilaterally.

The diagnosis was metopic suture craniosynostosis.

Infant with a pointy head

3D CT of metopic craniosynostosis — Axial CT without contrast of the brain (left) shows fusion of the metopic suture in the midline and a triangular appearance to the anterior aspect of the skull (trigonocephaly). Anterior 3D CT reconstruction (right) shows a prominent midline ridge in the anterior skull and hypotelorism with quizzical eye deformities present bilaterally.

The diagnosis was metopic suture craniosynostosis.

Infant with flattening of the left posterior head

3D CT of unilateral lambdoid craniosynostosis — Lateral (above) and superior (below left) and posterior (below right) 3D CT reconstructions of the skull show flattening of the left posterior skull and fusion of the left lamboid suture. The bilateral coronal sutures, sagittal suture, and right lambdoid suture are patent.

The diagnosis was left lambdoid suture craniosynostosis.

Newborn with a shortened appearance of the head

Radiograph of bilateral coronal craniosynostosis — AP and lateral radiographs of the skull show bilateral elevation of orbital roofs resulting in bilateral harlequin eye deformities. The coronal sutures appear sclerotic and fused along their middle and inferior aspects. The sagittal suture and bilateral lambdoid sutures are patent.

The diagnosis was bilateral coronal craniosynostosis.

Newborn with an unusual head shape

Radiograph and 3D CT of cloverleaf skull — AP (above left) and lateral (above right) radiographs of the skull and anterior (below left) and lateral (below right) 3D CT reconstructions of the skull show fusion of the bilateral coronal sutures, bilateral lambdoid sutures, metopic suture and anterior and posterior aspects of the sagittal suture. There is compensatory widening of the bilateral squamosal sutures. Hypotelorism is present and there are quizzical eye deformities present bilaterally.

The diagnosis was cloverleaf skull.

Newborn with respiratory distress, a heart murmur and a head bruit

US of vein of Galen malformation — Coronal grayscale US of the head (above left) shows a large round hypoechoic structure in the midline between the posterior horns of the lateral ventricles and above the cerebellum on the sagittal grayscale US (above right) which on color doppler (below) has turbulent blood flow within it.

The diagnosis was Vein of Galen malformation.

School ager with sinus pain and a cough

Sinus radiograph of sinusitis in Kartagener syndrome — Waters radiograph of the sinuses shows mucosal thickening and opacification of the bilateral maxillary sinuses, left greater than right.

The diagnosis was sinusitis in a patient with Kartagener syndrome.

School ager hit by an all terrain vehicle with neck pain

CT of retroclival hematoma — Sagittal 2D reconstruction from CT without contrast of the cervical spine shows a rounded area of increased density inferior to the tip of the clivus and superiorly and posteriorly to the C2 vertebral body.

The diagnosis was a retroclival hematoma with no associated cervical spine fracture.

School ager with neck pain whose brother sat on his back

CT and MRI of C7 spinous process fracture / Clay shoveler fracture — Lateral radiograph of the cervical spine shows a lucency through the middle part of the spinous process of the C7 vertebral body. Sagittal STIR MRI without contrast of the cervical spine shows bright signal representing edema in the interspinous ligaments between the C6-C7 and C7-T1 vertebral bodies.

The diagnosis was a spinous process of the C7 vertebral body (Clay shoveler) fracture with associated interspinous ligamentous sprain.

Teenager in motor vehicle accident with neck pain

CT of C7 spinous process fracture / Clay shoveler fracture — Axial and sagittal 2D reconstruction from a CT without contrast of the cervical spine shows a lucency through the middle part of the spinous process of the C7 vertebral body.

The diagnosis was a spinous process of the C7 vertebral body (Clay shoveler) fracture.

School ager in motor vehicle accident with neck pain

CT of fracture of C2 vertebral body / Hangman fracture — Axial CT without contrast of the cervical spine (upper left) shows lucencies through both pedicles of the C2 vertebral body. Midline sagittal 2D reconstruction (upper right) shows anterior dislocation of the C2 vertebral body on the C3 vertebral body. Left sagittal (lower left) and right sagittal 2D reconstructions (lower right) again show lucencies through the bilateral C2 pedicles and bilateral anterior perching of the C2 inferior facets on the C3 vertebral body.

The diagnosis was fracture / dislocation of the C2 vertebral body with bilateral perched facets (Hangman fracture).

Teenager with neck pain who was tackled by caregiver

CT of fracture / dislocation of C6 vertebral body with perched facets — Sagittal 2D reconstructions from a CT without contrast of the cervical spine shows the C6 vertebral body displaced anteriorly in relation to the C7 vertebral body (left) and anterior perching of the left inferior C6 facet (middle) and right inferior C6 facet (right) upon the C7 vertebral body.

The diagnosis was fracture / dislocation of the C6 vertebral body with bilateral perched facets.

Teenager in a rollover MVA with neck pain

CT of fracture of the left pedicle of the C6 vertebral body — Axial CT (left) without contrast of the cervical spine with sagittal 2D reconstruction (right) shows a lucency through the left pedicle of the C6 vertebral body.

The diagnosis was a fracture through the left pedicle of C6.

Teenager with neck pain who dove into a shallow pond and felt a pop in their neck

CT of compression fracture of C6 vertebral body — Axial (above) and coronal (left below) 2D reconstruction from CT without contrast of the cervical spine shows a lucency through the center of the C6 vertebral body. Sagittal 2D reconstruction (lower right) shows loss of height of the C6 vertebral body.

The diagnosis was compression fracture of C6.

Teenager ejected from the car in a motor vehicle accident with neck pain

CT of compression fracture of C7 vertebral body — Coronal (left) and sagittal (right) 2D reconstructions from a CT without contrast of the cervical spine show lucencies through the anterior and posterior aspects of the C7 vertebral body with loss of vertebral body height noted best on the sagittal image.

The diagnosis was a compression fracture of C7.

Teenager in motor vehicle accident with neck pain

CT of C2 vertebral body / Hangman fracture — Axial CT without contrast of the cervical spine (top) shows a lucency extending through the left C2 facet and another lucency extending through the right transverse process and involving the right transverse foramen which raised concern for possible right vertebral artery injury which was ruled out on a subsequent CT angiogram of the neck. Sagittal 2D reconstructions from the left, center and right of the cervical spine shows lucencies through the left C2 facet (left image), right transverse process (right image) and anterior inferior aspect of the C2 vertebral body (center 2 images).

The diagnosis was a fracture of C2 (Hangman fracture) without anterolisthesis of C2 on C3.

Teenager in motor vehicle accident with neck pain

CT of fracture / distraction of C2 vertebral body — Sagittal (left) and coronal (right) 2D reconstructions from a CT without contrast of the cervical spine shows an oblique lucency through the C2 vertebral body with distraction of the fracture fragments. There is marked prevertebral soft tissue swelling throughout the cervical spine.

The diagnosis was a fracture-distraction of C2.