Newborn with hydrocephalus on prenatal US

MRI of Blake pouch cyst — Axial (above), sagittal (below left), and coronal (below right) T2 MRI without contrast of the brain shows dilation of the lateral and third ventricles. The cerebellum is small in size and there is a large and fluid-filled posterior fossa.

The diagnosis was Blake pouch cyst.

School ager with seizures

MRI and CT of arrested pneumatization of the skull base — Axial T1 MRI without contrast of the brain (above left) shows an isointense signal intensity lesion in the right sphenoid bone that on T2 MRI (above right) shows a high signal intensity and which did not show enhancement post contrast. The remaining paranasal sinuses are clear. Coronal CT without contrast of the maxillofacial bones (below) shows the right sphenoid bone to be filled with a lucent non-expansile and non-destructive lesion.

The diagnosis was arrested pneumatization of the skull base.

Preschooler after cardiac arrest

CT and CT angiogram of giant intracranial aneursym — Axial CT without contrast of the head (above) shows a round mixed density lesion just to the right of the third ventricle along with diffuse subarachnoid hemorrhage and cerebral edema. Axial (below left) and sagittal (below right) CT angiogram shows the lesion to arise from the A1 segment of the right anterior cerebral artery.

The diagnosis was giant intracranial aneurysm which had ruptured causing subarachnoid hemorrhage and diffuse cerebral edema.

Newborn with seizures

CT and MRI of neonatal acute ischemic stroke — Axial CT without contrast of the brain (above left) shows a triangular area of decreased density in the right anterior watershed region. Axial T2 MRI of the brain (above right) shows loss of the normal sulcal and gyral pattern in the right anterior watershed region due to cerebral edema. Diffusion-weighted imaging of the brain (below) shows a large triangular region of diffusion restriction in the right anterior watershed.

The diagnosis was neonatal acute ischemic stroke.

Toddler with right handed weakness since birth

MRI of chronic sequelae from neonatal acute ischemic stroke — Axial T2 MRI without contrast of the brain (above) shows marked asymmetric enlargement of the left lateral ventricle along with a paucity of white matter in the left cerebral hemisphere which is further demonstrated on the coronal T1 MRI (below).

The diagnosis was chronic sequelae of neonatal acute ischemic stroke.

School ager with diffuse scrotal hyperesthesia and pain

MRI of arachnoid cyst of the sacrum — Sagittal color doppler US of the left (above left) and right (below left) testicles shows normal appearing color doppler flow to each testicle which was confirmed on spectral dopper US. Sagittal T2 MRI without contrast of the lumbar spine (right) shows a large cylindrical structure filling the sacral spinal canal from S1-S5 whose signal intensity followed cerebrospinal fluid on all sequences.

The diagnosis was arachnoid cyst of the sacrum.

Teenager in motor vehicle accident with altered mental status

CT of diffuse axonal injury — Axial CT without contrast of the brain obtained initially (left) shows loss of delineation of the cortical sulci and ventricular system. Axial CT without contrast obtained two days later (right) now also shows a round focus of hyperdensity at the right parietal gray matter white matter junction.

The diagnosis was diffuse cerebral edema and delayed appearance of diffuse axonal injury.

Newborn with a large posterior skull mass

Radiograph of encephalocele — Lateral radiograph of the skull shows a large round soft tissue mass arising from the base of the skull.

The diagnosis was occipital encephalocele.

School ager with fauns tail on the back

Myelogram of diastematomyelia — AP vintage conventional myelogram at the level of the thoracolumbar junction shows an oval filling defect in the center of the thecal sac.

The diagnosis was diastematomyelia.

Toddler with otitis media

CT of coalescent mastoiditis — Axial CT without contrast of the face (left) shows partial opacification of the ethmoid sinuses and complete opacification of the mastoid air cells bilaterally. The lateral wall of the left mastoid is irregular in contour. Axial CT without contrast (right) shows an inflammatory soft tissue mass around the left ear.

The diagnosis was bilateral mastoiditis with left coalescent mastoiditis.

School ager with cafe au lait spots and upper back pain

Tomogram of plexiform neurofibroma causing painful scoliosis — Coronal conventional tomogram of the thoracic spine shows a soft tissue mass in the apex of the right lung causing scalloping of the right side of the upper thoracic vertebral bodies and a scoliosis convex left.

The diagnosis was a paraspinal plexiform neurofibroma causing painful scoliosis in a patient with neurofibromatosis Type 1.

School ager with fauns tail on the back

CT of diastematomyelia — Axial CT without contrast of the lumbar spine shows a piece of bone bisecting the spinal canal.

The diagnosis was diastematomyelia.

School ager with several days of vomiting

CT and MRI of cerebellar astrocystoma — Axial CT without contrast of the brain (above) shows moderate dilation of the lateral, third and fourth ventricles. Axial T2 MRI without contrast of the brain (below left) shows a round focus of bright signal in the posterior medulla that on the sagittal T1 MRI post contrast (below right) shows it to be a non-enhancing mass in the floor of the fourth ventricle causing ventricular outlet obstruction.

The diagnosis was cerebellar astrocytoma.

Preschooler with a faun’s tail in the midline of the back at the thoraco-lumbar junction

Radiograph of diastematomyelia — AP radiograph of the thoracolumbar spine shows a bone spur in the midline of the spinal canal at the T12-L1 level.

The diagnosis was diastematomyelia.

School ager with a faun’s tail in the middle of the lower back

CT of diastematomyelia — Vintage AP tomogram obtained through the posterior elements of the lumbar spine (left) shows a linear piece of bone in the midline between the L3 and L4 vertebral bodies. Axial CT without contrast of the spine (right) through the L3/L4 disc space shows a piece of bone in the center of the spinal canal

The diagnosis was diastematomyelia.

Infant with a faun’s tail on the midline of their back

Myelogram of diastematomyelia — AP image from a vintage lumbar myelogram exam after injection of contrast in the spinal canal shows an ovoid filling defect in the center of the spinal canal from L1 to L2.

The diagnosis was diastematomyelia.

Teenager with headache, diplopia and balance problems

CT of pleomorphic xanthoastrocytoma — CT without contrast of the brain shows a large heterogenous mass in the anterior right hemisphere that has faint linear calcifications, a marked amount of surrounding edema, and mass effect to the left.

The diagnosis was pleomorphic xanthoastrocytoma.

Newborn with a nasal mass on prenatal ultrasound

CT of nasal teratoma — Lateral radiograph of the skull (above) shows a large nasal mass. Axial CT without contrast of the skull (below) shows a large heterogenous mass extending via a thin stalk from the unopposed nasal bones that contained soft tissue, fat and calcified components. There was no intracranial extension.

The diagnosis was nasal teratoma.

Preschooler with a midline neck mass

I-123 scan of thyroglossal duct cyst containing thyroid tissue — Anterior view of a I-123 thyroid scan shows tracer uptake in a single midline region that corresponds directly to the patient’s midline neck mass, without any demarcation of the lobes of the thyroid. There was no other thyroid uptake in the neck.

The diagnosis was thyroglossal duct cyst containing thyroid gland tissue.

Infant with a VP shunt and decreased activity for the last few days

Skull radiograph of VP shunt disconnection — Lateral radiograph of the skull obtained after VP shunt placement 3 months ago (above) shows all of the parts of the VP shunt to be connected together. Current lateral radiograph of the skull (below) shows an increasing space between the superior portion of the VP shunt and the reservoir beneath it, thus the superior part of the VP shunt is disconnected from the reservoir.

The diagnosis was ventriculoperitoneal shunt discontinuity.

Toddler with cerebral palsy who fell down the stairs

CT and angiogram of Vein of Galen malformation — Axial CT without contrast of the brain (left) shows a marked amount of hydrocephalus, diffuse intracranial calcifications, and no intracranial hemorrhage. A tubular structure is noted in the midline posteriorly between the occipital horns of the lateral ventricles. Lateral image from a cerebral angiogram (right) arterial injection shows enlarged posterior choroidal and lenticulostriate arteries feeding an arteriovenous malformation which drains into enlarged transverse sinuses bilaterally.

The diagnosis was Vein of Galen malformation.

Preschooler with short stature and a large skull

Radiograph of skull in achondroplasia — Lateral radiograph of the skull shows small facial bones and a relatively large cranium.

The diagnosis was achondroplasia.

School ager with sore throat

CT of palatine tonsil hypertrophy — Axial CT with contrast of the neck (left) shows bilaterally enlarged palatine tonsils that nearly meet in the midline, while the sagittal image (right) shows the enlarged dumbbell shaped palatine tonsils nearly occluding the airway.

The diagnosis was palatine tonsillar hypertrophy.

Newborn with a sacral dimple

Spine US of normal position of the conus medullaris — Sagittal US of the lumbar spine shows the conus medullaris to be in a normal position at the L2 vertebral body.

The diagnosis was normal spine US with no evidence of tethered cord.

Infant dropped by parent

CT of subgaleal hematoma — Axial CT without contrast of the brain shows a left parietal depressed skull fracture with high density material in the adjacent subgaleal space that crosses sutures and courses around to the right side of the skull.

The diagnosis was a depressed skull fracture causing a subgaleal hematoma.