Preschooler with sickle cell disease

MRA of sickle cell disease causing near total occlusion of the left internal carotid artery — AP MRA of the neck with contrast (above) shows near total occlusion of the left internal carotid artery. AP MRA of the brain with contrast (below) shows the left internal carotid artery to be small in caliber and to have a beaded appearance. The left middle carotid artery is reconstituted throug the anterior communicating artery.

The diagnosis was sickle cell disease causing near total occlusion of the left internal carotid artery.

Toddler with spasms

MR of pineal cyst — Sagittal (above left), axial (above right) and coronal (below left) T1 MRI without contrast of the brain shows a small round low signal intensity lesion with thin walls in the location of the pineal gland. Coronal T2 MRI (below right) shows the lesion to have high signal intensity.

The diagnosis was pineal cyst.

Young adult with a left neck mass

US of follicular thyroid adenoma — Transverse ultrasound of the thyroid (above) shows a single small nodule in the right lobe of the thyroid and a large nodule in the left lobe of the thyroid. Longitudinal ultrasound image of the left lobe of the thyroid (below) shows there are three nodules in the left lobe of the thyroid. Each thyroid nodule has a thin peripheral halo, is predominantly solid and homogenously isoechoic and has an absence of internal flow.

The diagnosis was follicular thyroid adenoma.

School ager with fever and left neck stiffness

CT of parapharyngeal abscess — Axial CT with contrast of the neck shows a round, well circumscribed, low density lesion in the left parapharyngeal space that has mild peripheral enhancement.

The diagnosis was left parapharyngeal abscess.

Newborn who underwent vacuum extraction during a difficult delivery

CT of cerebellar hemorrhage — Axial (left) and coronal (right) CT without contrast of the brain shows a small, round, dense lesion in the left cerebellar hemisphere. The coronal image also shows a dense fluid collection in the left superior subcutaneous tissues of the skull which crosses the sagittal suture in the midline.

The diagnosis was left cerebellar hemorrhage and left subgaleal hematoma.

Newborn with a sixth cranial nerve palsy

US of subependymal cyst — The diagnosis was subependymal cyst most likely due to neonatal intraventricular hemorrhage Grade I.

The diagnosis was subependymal cyst most likely due to neonatal intraventricular hemorrhage Grade I.

Preschooler with eye pain

MRI of developmental venous anomaly — Axial (above) and coronal (below) T1 MRI with contrast of the brain shows a caput medusa sign of many small veins draining into a single larger collecting vein.

The diagnosis was developmental venous anomaly in the left frontal lobe.

Teenager with acute onset of left orbital pain

CT of idiopathic orbital inflammation — Axial (left) and coronal (right) CT with contrast of the orbits shows diffuse thickening of the muscle belly of the left lateral rectus muscle. No other inflammatory changes were seen in the orbits.

The diagnosis was idiopathic orbital inflammation.

Premature newborn with metabolic acidosis

Head US of choroid plexus hemorrhage — Coronal (left) and left sagittal (right) US of the brain shows the left-sided choroid plexus in the left lateral ventricle to be abnormally enlarged, irregular in contour and heterogenous in appearance when compared to the normal right-sided choroid plexus in the right lateral ventricle.

The diagnosis was left-sided choroid plexus hemorrhage.

Newborn with a scalp defect

CT of aplasia cutis — 3D CT without contrast of the skull viewed from above in soft tissue windows at 2 weeks of age (left) shows a defect in the scalp in the region of the anterior aspect of the sagittal suture. 3D CT without contrast of the skull viewed from above in bone windows done 10 years later (right) shows a defect in the skull in the region of the anterior aspect of the sagittal suture.

The diagnosis was aplasia cutis with a skull defect.

Teenager hit by a car

CT of atlanto-occipital dissociation — Coronal CT without contrast of the cervical spine (above left) shows a fracture through the left occipital condyle with the fracture fragment displaced inferiorly. Additionally, the occipital condyles do not articulate with the lateral masses of the C1 vertebral body. Left sagittal CT (above middle) again shows the left occipital condyle fracture and increased space between the left occipital condyle and the left lateral mass of C1. Right sagittal CT (above right) shows even more clearly the increased space between the right occipital condyle and the right lateral mass of C1. Midline sagittal CT (below) shows the basion-dens interval to be abnormally increased.

The diagnosis was atlanto-occipital dissociation.

Premature newborn with apnea and bradycardia

Head US of lenticulostriate vasculopathy — Coronal (above) and left sagittal (below left) and right sagittal (below right) US of the brain shows linear branching areas of increased echogenicity in the basal ganglia

The diagnosis was lenticulostriate vasculopathy.

School ager with paralysis after sepsis

MRI of Guillain-Barre syndrome — Sagittal (left and middle) and axial (right) T1 MRI with contrast of the lumbar spine shows diffuse enhancement of the anterior and posterior nerve roots of the cauda equina.

The diagnosis was Guillain-Barre syndrome.

Teenager with developmental delay

MRI of Joubert syndrome — Axial T1 MRI without contrast of the brain (left) shows thickened and horizontal superior cerebellar peduncles giving the midbrain the appearance of a molar tooth and the fourth ventricle is enlarged. A lower image (right) shows cerebellar vermian hypoplasia.

The diagnosis was Joubert syndrome.

Toddler with a sacral dimple

MRI of lipoma of the filum terminale and tethered cord — Sagittal T1 MRI without contrast of the lumbar spine (left) shows hyperintense signal in the conus medullaris which lies low in position at the level of L2-L3. Axial T1 MRI through the conus (right) better shows the hyperintense signal in the conus which is the same signal intensity as the subcutaneous fat.

The diagnosis was lipoma of the filum terminale and tethered cord.

Premature newborn with apnea and bradycardia

US of cerebellar hemorrhage — Coronal US of the brain (above) shows round areas of increased echogenicity in the cerebellar hemispheres, left larger than right which are also seen on the sagittal US of the left cerebellum (lower left) and right cerebellum (lower right). The ventricular system was dilated due to bilateral intraventricular hemorrhage (not pictured).

The diagnosis was bilateral neonatal cerebellar hemorrhage.

School ager with headaches and visual disturbances

CT of pineoblastoma — Axial (above left), coronal (above right) and sagittal (below) CT without contrast of the brain shows a large, round, high density mass in the region of the pineal gland causing obstructive hydrocephalus and transependymal flow of cerebrospinal fluid. The right frontal intracranial air on the axial image is due to recent placement of a ventriculoperitoneal shunt.

The diagnosis was pineoblastoma.

Premature newborn with apnea and bradycardia

US and MRI of periventricular leukomalacia and porencephaly — Coronal US of the brain on day of life 3 (above left) shows bilateral increased periventricular echogenicity. Coronal US of the brain on day of life 30 (above right) shows the previously seen areas of increased periventricular echogenicity to have undergone cystic transformation bilaterally. Axial T2 MRI without contrast of the brain at 3 months of age (below) shows an irregular contour and appearance to the occipital horns of the lateral ventricles.

The diagnosis was bilateral periventricular leukomalacia resulting in bilateral porencephaly.

Newborn with a seizure

MRI of subpial hemorrhage — Axial (above) and coronal (below) T2 MRI without contrast of the brain shows a large ellipsoid collection of low signal intensity fluid in the right temporal lobe primarily located just underneath a preserved cortical ribbon in the subpial space with some intraparenchymal component which has associated edema in the right temporal lobe and which is causing midline shift to the left.

The diagnosis was subpial hemorrhage.

Infant with an occipital mass

CT and MRI and MRV of sinus pericranii — Sagittal CT without contrast of the brain (above left) shows an occipital skull defect just below the mass. Sagittal T1 MRI without contrast of the brain (above right) shows multiple small flow voids in the mass. MRV with contrast of the brain (below) shows a persistent falcine sinus.

The diagnosis was sinus pericranii.

Teenager with a left cheek mass

MRI of pleomorphic adenoma — Axial T1 MRI with contrast of the face (above left) shows a low signal intensity oval mass centered in the left parotid gland that on axial T2 MRI (above right) has high signal intensity and that on axial (below left) and coronal (below right) T1 MRI with contrast shows marked homogenous enhancement.

The diagnosis was pleomorphic adenoma.

Toddler with multiple congenital cutaneous nevi on their back

MRI of neurocutaneous melanosis — Axial T1 MRI without contrast of the brain shows asymmetrically increased signal intensity in the right mesial temporal lobe (left) and in the right cerebellar hemisphere (right).

The diagnosis was neurocutaneous melanosis.

Newborn with a seizure

US of choroid plexus cyst — Coronal (above) and right of midline sagittal (below) US of the brain shows a small, round, anechoic structure in the right choroid plexus.

The diagnosis was choroid plexus cyst.

Newborn with a bump on the back of the head

MRI of atretic cephalocele — Sagittal T2 (above left) and sagital CISS (above right) MRI without contrast of the brain shows a fluid filled parietal lesion that contains meninges and that is connected by a short stalk to the dura. A persistent falcine sinus is present. Axial T2 MRI (below) shows the lesion to be in the midline.

The diagnosis was atretic cephpalocele.

Teenager with a seizure disorder on anti-seizure medication

CT of calvarial thickening due to phenytoin usage — Axial CT without contrast of the brain shows diffuse thickening of the diploic spaces in the skull.

The diagnosis was calvarial thickening due to phenytoin usage.