School ager with right facial swelling due to an infected right maxillary tooth

CT of periapical abscess — Axial CT with contrast of the face (above) shows a low density fluid collection surrounded by an enhancing rim just to the right of midline and just anterior to the teeth. Sagittal CT (below) shows the fluid collection to be bilobed and coursing from the right maxilla up to the right orbit.

The diagnosis was periapical abscess.

Preschooler with right neck swelling

US of benign reactive lymphadeopathy — Transverse US of the neck shows two enlarged lymph nodes, each of which has a central echogenic hilum.

The diagnosis was benign reactive lymphadenopathy.

Infant with posterior rib fractures and subdural hematomas who has been abused

3D CT of diastatic skull fractures due to child abuse — 3D CT without contrast of the skull shows bilateral almost symmetrical transverse and longitudinal fractures in the parietal bones.

The diagnosis was bilateral diastatic skull fractures due to child abuse.

Former 31 week premature newborn now 3 days old with apnea and bradycardia

US, CT and MRI of Herpes simplex virus-2 encephalitis — Coronal US of the brain (above left) shows increased periventricular echogenicity around the anterior horns of the lateral ventricles with cystic change on the right. Axial CT without contrast of the brain (above right) shows diffuse low density throughout the brain with loss of gray matter white matter differentiation and high density hemorrhage in the posterior horn of the left lateral ventricle and in the right basal ganglia. Coronal (below right) and axial (below left) T2 MRI of the brain show diffuse necrosis developing in the brain, particularly in the frontal lobes. Intraventricular hemorrhage is again noted and the brain appears to be too smooth in appearance for the gestational age.

The diagnosis was Herpes simplex virus-2 encephalitis.

Teenager with nose pain after being punched in the nose

Radiograph of nasal bone fracture — Bilateral radiographs of the nose show lucent lines through the middle parts of both nasal bones.

The diagnosis was bilateral non-displaced nasal bone fractures.

Teenager with buttocks pain after fall onto buttocks

Radiograph of coccygeal fracture — Lateral radiograph of the sacrum shows irregular alignment of the coccyx and fragmentation of the distal coccyx.

The diagnosis was coccyx fracture.

School ager with back pain and incontinence who has been unable to walk for several weeks

CT and MRI of aneurysmal bone cyst of the spine — Sagittal (above left) and axial (above right) CT without contrast of the cervical spine shows an expansile lytic lesion with a thin margin in the spinous and transverse processes of the T1 vertebral body. There is marked anterolisthesis of T1 on T2. Sagittal T2 MRI without contrast of the cervical spine (below left) shows the anterolisthesis at T1 and T2 causing extreme cord compression while an axial T2 MRI obtained at this level (below right) shows a fluid-fluid level in the lesion to the anterior and right of the vertebral body.

The diagnosis was aneurysmal bone cyst of the spine.

Teenager with papilledema

MRI of empty sella in idiopathic intracranial hypertension — Sagittal T1 MRI with contrast of the brain shows the pituitary gland to be thinned and flattened in appearance. Most of the sella is filled with cerebrospinal fluid.

The diagnosis was empty sella due to idiopathic increased intracranial hypertension.

Teenager punched in the left eye

CT of left orbital blowout fracture — Coronal CT without contrast of the orbits in soft tissue (above) and bone (below) windows shows a fracture defect in the floor of the left orbit with fat herniating through it into the left maxillary sinus.

The diagnosis was left orbital blowout fracture.

Preschooler with left leg weakness and back pain

MRI of diffuse leptomeningeal glioneuronal tumor — Sagittal T1 MRI without contrast of the spine (above left) shows a focal protruberant intramedullary mass in the spinal cord at C7 and T1 that is hyperintense on sagittal T2 MRI (above center) and that on the sagittal T1 MRI with contrast (above right) enhances minimally. There is also thick leptomeningeal enhancement anterior and posterior to the cervical spine. The sagittal T1 MRI with contrast of the brain (below) shows thick leptomeningeal enhancement of the brain, particularly around the basal cisterns.

The diagnosis was diffuse leptomeningeal glioneuronal tumor.

Teenager in a motor vehicle accident with back pain

CT of Chance fracture of L1 vertebral body — Coronal (above left), sagittal (above right) and axial (below) CT without contrast of the lumbar spine shows a flexion distraction fracture of the L1 vertebral body and its posterior elements and a compression fracture of the L4 vertebral body.

The diagnosis was a Chance fracture of the lumbar spine at the L1 vertebral body and a lumbar spine fracture of the L4 vertebral body.

School ager with left upper eyelid swelling

MRI of dacryoadenitis — Coronal T2 MRI without contrast of the orbit (above left) shows hyperintense signal in a superolateral distribution around the left orbit including the left lacrimal gland. Coronal (above right) and axial (below) T1 MRI with contrast shows bright homogenous enhancement in a superolateral distribution around the left orbit including the left lacrimal gland.

The diagnosis was left dacryoadenitis.

Teenager in motor vehicle accident with back pain

CT of lumbar spine fracture of L1 vertebral body — Sagittal CT without contrast of the lumbar spine (left) shows a compression fracture of the L1 vertebral body with fracture fragments off of the anterior and posterior aspects of the L1 vertebral body and a mild compression fracture of the L3 verebral body. Sagittal T2 MRI without contrast of the lumbar spine (right) shows the posterior fracture fragment off of L1 to be effacing the thecal sac anteriorly and causing compression of the spinal cord. There is also bright signal in the L1 vertebral body secondary to the compression fracture.

The diagnosis was a lumbar spine fracture of L1 vertebral body causing cord compression and a lumbar spine compression fracture of L3 vertebral body.

School ager post trauma

CT of colloid cyst — Axial CT without contrast of the brain shows a small, round, high density lesion in the midline in the anterior superior aspect of the third ventricle at the Foramen of Monro. The lesion could not be seen on an MRI performed at the same time.

The diagnosis was colloid cyst of the third ventricle.

Preschooler who sustained penetrating trauma to the skull base with a rake

MR myelogram of cerebrospinal fluid leak due to dural tear — Sagittal MR myelogram (above left) shows leakage of hyperintense cerebrospinal fluid into the soft tissues inferior to the cerebellum, which lateralizes to the left side on the coronal MR myelogram (above right). Sagittal T2 MRI without contrast of the brain (below) shows the tear in the linear hypointense dura with the hyperintense cerebrospinal fluid leaking through it just inferior to the tip of the cerebellar tonsil.

The diagnosis was cerebrospinal fluid leak due to a dural tear.

Teenager with back pain after jumping off a truck

CT of thoracic spine fracture dislocation with epidural hematoma and cord compression — Coronal (left) and sagittal (middle) CT without contrast of the spine shows fracture of the T6 and T8 vertebral bodies with displacement at T7-T8. Sagittal T2 MRI without contrast of the spine (right) shows spinal stenosis and cord compression and abnormal cord signal and ligament disruption and an epidural hematoma at T7-T8.

The diagnosis was fracture dislocation of the thoracic spine with a spinal epidural hematoma.

Teenager after motor vehicle accident

CT of transverse fracture of temporal bone — Axial CT without contrast of the temporal bone shows a fracture line oriented perpendicular to the long axis of the petrous temporal bone that goes through both walls of the carotid canal. There was a small amount of intracranial air. The right interal carotid artery was normal in appearance on a subsequent CT angiogram.

The diagnosis was right transverse temporal bone fracture.

Teenager who fell

CT of transverse fracture of temporal bone — Axial CT without contrast of the temporal bone shows a fracture line perpendicular to the right petrous temporal bone long axis (left) and a small amount of intracranial air (right). The mastoid air cells are opacified.

The diagnosis was transverse fracture of the right temporal bone.

Preschooler with vomiting and headaches

MRI of tectal glioma — Sagittal T1 MRI without contrast of the brain (above left) shows an isointense lesion in the tectum and in the pineal gland which on sagittal FLAIR (above right) appears to shows low signal intensity representing perhaps calcification in its pineal component. The lesion is causing dilation of the third ventricle. Axial T2 MRI (below left) shows dilation of the lateral ventricles and transependymal flow of cerebral spinal fluid. Axial T1 MRI with contrast (below right) shows enhancement in the mass.

The diagnosis was tectal glioma that may also involve the pineal gland.

Infant who had suffered non-accidental trauma

MRI of spinal subdural hematoma — Sagittal T1 MRI without contrast of the spine (left) shows a small linear high signal intensity fluid collection posterior to the C7 vertebral body that is low signal intensity on sagittal T2 MRI (middle) and dark on sagittal GRE MRI (right).

The diagnosis was spinal subdural hematoma.

School ager who fell off a motorcycle

CT of longitudinal temporal bone fracture — Axial CT without contrast of the temporal bones shows a fracture line running parallel to the long axis of the right petrous temporal bone. Disruption of the ossicles is also present.

The diagnosis was a right longitudinal temporal bone fracture.

School ager with new headaches

MRI of acute cerebellitis — There is loss of differentiation of the cerebellar folia due to cerebellar edema seen as the cerebellar folia having low signal intensity on axial T1 MRI without contrast (below left), high signal intensity on axial T2 MRI (above right) and mild enhancement on axial T1 MRI with contrast (below right). The ventricular system is also dilated on axial T2 MRI (above left).

The diagnosis was acute cerebellitis.

Teenager with midline back pain

CT of Schmorl nodes — Sagittal CT without contrast of the thoracic spine shows nodular lucent lesions along the superior and inferior aspects of multiple vertebral bodies with some of these lesions having sclerotic margins.

The diagnosis was Schmorl nodes.

Infant who fell 4 feet

CT of ping pong fracture of skull — Axial (above left) and coronal (above right) CT without contrast of the brain show a depression in the left side of the skull. There was no intracranial hemorrhage. The depression is better seen on the 3D CT (below).

The diagnosis was a depressed ping pong fracture of the skull.

Teenager with pharyngitis and trismus

CT of peritonsillar abscess — Axial (above), coronal (below left) and sagittal (below right) CT with contrast of the neck show an enlarged left palatine tonsil with a low density round lesion lateral to it and associated inflammatory change in the left parapharyngeal space.

The diagnosis was peritonsillar abscess.