School ager with severe combined immune deficiency and right facial swelling and tenderness

CT of pediatric parotitis — Axial (above) CT with contrast of the face shows lymphoepithelial cysts in the parotid glands bilaterally. Coronal CT (below) shows the right parotid gland is enlarged and hyperemic and surrounded by inflammation. A right intraparotid lymph node is present.

The diagnosis was right parotitis.

Teenager in a motor vehicle accident

CT of mastoid fracture — Axial CT without contrast of the maxillofacial bones shows a linear lucent line through the lateral aspect of the right mastoid bone with resultant opacification of the mastoid air cells. There was associated diastasis of the right lambdoid suture.

The diagnosis was right mastoid fracture.

Teenager with facial trauma

CT of mandibular fracture — 3D CT without contrast of the face shows a fracture line without displacement through the angle of the left mandible (above) and a fracture line with displacement through the body of the right mandible (below).

The diagnosis was a nondisplaced fracture of the left mandible and a displaced fracture of the right mandible.

School ager hit in the left eye with a screw

CT of globe rupture — Axial CT without contrast of the orbits shows loss of the normal spherical shape of the left globe with some fluid present anteromedial to it. The left lens is not visualized. In the operating room there was a defect in the anteromedial aspect of the left globe

The diagnosis was left globe rupture.

Young adult with back pain who fell from a height of 20 feet

CT of anterior and posterior column fractures of the lumbar spine — Sagittal CT without contrast of the lumbar spine shows a fracture of the anterior and posterior columns of the L1 vertebral body and fractures of the anterior columns of the L2 and L3 vertebral bodies.

The diagnosis was lumbar spine fracture of L1-L3.

School ager with Factor 9 deficiency who has neck pain after being hit while playing football

MRI of subdural hematoma of the cervical spine. — Sagittal T1 (above leftmost), T2 (above left middle), STIR (above right middle) and gradient echo (above rightmost) MRI without contrast of the cervical spine shows a long linear fluid collection anterior to the cervical spinal cord from C1-C7 that is isointense on T1 weighted imaging, mixed isointense and hyperintense on T2 weighted imaging, and hyperintense on STIR and gradient echo imaging. On the axial T1 (below left) and T2 (below right) MRI the fluid collection is oval in shape and is seen anterior to the spinal cord and is causing compression on the spinal cord.

The diagnosis was cervical spinal subdural hematoma.

Teenager who was hit in the right eye by an elbow

CT of subtle orbital blowout fracture — Coronal CT without contrast of the orbits obtained immediately after the injury in soft tissue (above left) and bone (above right) windows show a very small amount of soft tissue herniated into the roof of the right maxillary sinus. No fracture line was identified. Repeat coronal CT without contrast of the orbits obtained two days after the injury in soft tissue (below left) and bone (below right) windows now shows a large amount of soft tissue herniated into the roof of the right maxillary sinus.

The diagnosis was right orbital blowout fracture. In the operating room there was entrapment of the right inferior rectus muscle which was ischemic.

School ager hit by a car while riding their bicycle

CT of non fusion of left synchondrosis of C1 — Axial CT without contrast of the cervical spine shows non-fusion of the left synchondrosis in the C1 vertebral body.

The diagnosis was congenital developmental anomaly of the cervical spine with non fusion of the left C1 synchonrosis.

School ager with ventriculoperitoneal shunt and new headache

MRI of overshunting of the lateral ventricles — Axial T2 MRI without contrast of the brain from 1 year ago (left) shows normal size of the anterior and posterior horns of the lateral ventricles. The tip of the ventriculoperitoneal shunt (not shown) was in a correct position. Axial T2 MRI without contrast of the brain from today (right) shows interval decrease in size of the anterior and posterior horns of the lateral ventricles which appear slit-like. The tip of the ventriculoperitoneal shunt (not shown) was in a correct position.

The diagnosis was ventriculoperitoneal shunt malfunction in the form of overshunting in a patient with a ventriculoperitoneal shunt.

Newborn with a sacral dimple

US and MRI of tethered cord — Sagittal US of the spine (above) shows an extremely low lying conus which appears to extend as far as S1. Sagittal T2 MRI without contrast of the spine (below) shows the conus to be located around L5-S1.

The diagnosis was tethered cord.

Infant with a port-wine stain in the left V1 distribution

MRI of Sturge-Weber syndrome — Axial (above left), coronal (above right) and sagittal (below) T1 MRI with contrast of the brain shows left-sided diffuse, marked leptomeningeal enhancement. There is mild cortical atrophy of the left cerebral hemisphere.

The diagnosis was Sturge-Weber syndrome.

Teenager with a bump on the right side of the skull

CT of arachnoid granulation — AP radiograph of the skull (above left) shows a lucent lesion that arises just to the left of the midline at the vertex of the skull. Bone windows from a coronal CT without contrast of the brain (above right) shows thinning of the inner table of the calvarium in that region. Soft tissue windows from sagittal (below left) and coronal CT (below right) show a cerebrospinal fluid density mass at the left parasagittal region adjacent to the superior sagittal sinus associated with the well-defined thinning of the inner table of the calvarium.

The diagnosis was arachnoid granulation.

Toddler who after a fall was found to have a left non reactive pupil and left leukocoria

CT of retinoblastoma — CT without contrast of the brain shows a round hyperdense lesion almost completely filling the left globe.

The diagnosis was retinoblastoma.

School ager with right eyelid swelling and redness and right eye pain

CT of orbital cellulitis and subperiosteal abscess — Axial CT with contrast of the orbits (above) shows opacification of the right ethmoid sinus, inflammatory changes within the right orbit, and a low density oval fluid collection with an enhancing wall between the right medial rectus muscle and the right ethmoid sinus. Coronal CT (below) shows how this fluid collection is displacing the right medial rectus muscle laterally.

The diagnosis was right ethmoid sinusitis causing right orbital cellulitis and subperiosteal abscess.

Newborn with a posterior skull mass

CT and MR of occiptal menigoencephalocele — Axial CT without contrast of the skull (above left and below left) shows a large primarily low density soft tissue mass in the midline of the posterior skull extruding through a large defect in the posterior skull (above right). Axial T2 MRI of the brain (below right) shows the mass contains a thin amount of neural tissue.

The diagnosis was occipital meningoencephalocele.

Newborn with a skin covered bump on his lower back

MR of lipomyelomeningocele — Sagittal T1 MRI without contrast of the spine (above) shows the conus medullaris to be low in position at L5 and to be contiguous with a lipomatous mass in the posterior spinal canal with neural elements extending from the low-lying cord through a defect in the bone posteriorly and being contiguous with subcutaneous fat. Axial T1 MRI at the level of the conus (below left) shows fat adherent to the conus posteriorly and the conus / neural tissue extending into the subcutaneous fat. Axial T2 MRI at the level of the conus (below right) also shows that there is some cerebrospinal fluid extending into the subcutaneous fat as well.

The diagnosis was lipomyelomeningocele.

Newborn with a palpable ridge along their forehead

Radiograph of metopic craniosynostosis — AP radiograph of the skull shows hypotelorism with quizzical eye deformities present bilaterally.

The diagnosis was metopic craniosynostosis.

Infant who has been abused

Radiograph of growing skull fracture / leptomeningeal cyst — Initial lateral radiograph of the skull (above) shows a stellate skull fracture in the parietal bone. Some of the skull fragments are also diastatic, or spread apart. Followup lateral radiograph of the skull obtained 3 weeks later (below) shows a widening distance between several of the skull fragments.

The diagnosis was growing skull fracture, also known as a leptomeningeal cyst.

Infant with a sacral dimple

MR of normal position of the conus medullaris — Sagittal T2 MRI of the lumbar spine (left) shows the tip of the conus medullaris to lie at the level of L1-L2. Sagittal T1 without contrast MRI (right) shows the low signal intensity posterior dermal sinus tract running linearly from the sacral dimple at the skin to the coccyx.

The diagnosis was normal position of the conus medullaris.

Toddler with a runny nose and right orbital swelling

CT of sinusitis with preseptal cellulitis and a subperiosteal abscess — Axial CT with contrast of the orbits (above) shows opacification of the ethmoid sinuses and sphenoid sinus along with right preseptal soft tissue swelling. There is a fluid collection with rim enhancment medially next to the wall of the right ethmoid sinus which is better seen on the coronal CT (below).

The diagnosis was sinusitis with preseptal cellulitis and a subperiosteal abscess.

Young adult with sickle cell disease and a headache

CT of calvarial thickening due to marrow hyperplasia in a patient with sickle cell disease — Axial (above left), coronal (above right) and sagittal (below) CT without contrast of the skull shows diffuse massive thickening of the diploic space of the skull.

The diagnosis was calvarial thickening due to marrow hyperplasia in a patient with sickle cell disease.

Teenager with nausea, vomiting and ataxia for 3 months

CT and MRI of cerebellar astrocytoma — Axial CT without contrast of the brain (above left) shows a primarily cystic lesion in the left cerebellar hemisphere that has a solid component posteriorly that contains calcification. There is mild to moderate obstructive hydrocephalus present. Axial (above right) and coronal (below left) T1 MRI with contrast of the brain shows a primarily cystic lesion in the left cerebellar hemisphere that has a solid component posteriorly that enhances. There is mild to moderate hydrocephalus present. Sagittal T1 MRI with contrast (below right) shows the cerebellar mass causing tonsillar herniation beneath the foramen magnum.

The diagnosis was cerebellar astrocytoma.

Teenager with a painful bump on the back of the head in the midline

Radiograph of external occipital protuberance. — Lateral radiograph of the skull shows a large bony spur originating from the occipital bone.

The diagnosis was external occipital protuberance.

Newborn with stridor

CT of laryngeal cyst — Sagittal (above left), coronal (above right) and axial (below) CT with contrast of the neck shows an oval, well circumscribed, low density lesion in the supraglottic region in close approximation to the right side of the epiglottis.

The diagnosis was laryngeal cyst.

Toddler with a sacral dimple

MRI of ventriculus terminalis — Sagittal T2 MRI without contrast of the spine (left) shows normal position of the conus. Near the end of the spinal cord is a focal area of dilation of the central canal of the spine. Axial T2 MRI (right) better shows the focal dilation of the distal central canal of the spinal cord.

The diagnosis was ventriculus terminalis.