Newborn with scalp swelling and bruising and decreased hemoglobin after a delivery by C-section for failure to descend

Skull radiograph of subgaleal hematoma — AP and lateral radiographs of the skull show diffuse soft tissue swelling of the scalp that crosses sutures and that is especially prominent over the left fronto-parietal region.

The diagnosis was subgaleal hematoma.

Teenager with nasal congestion for a week who now has a headache, fever, and has become obtunded

MRI of sinusitis, meningitis, and subdural empyema — Axial (above left and above middle) and coronal (above right) T1 MRI with contrast of the brain shows opacification and rim enhancement of the left ethmoid and frontal sinuses, diffuse enhancement of the left meninges, and subdural fluid collections along the left convexity and falx posteriorly. Axial diffusion weighted (lower left) and ADC (lower right) images show diffuse restriction in the left frontal sinus and parafalcine subdural fluid collections.

The diagnosis was pansinusitis with meningitis and subdural empyema.

Infant who fell out of their mother’s arms

CT of acute subdural hematoma with interhemispheric extension — Axial CT without contrast of the brain shows a high density crescent-shape extra axial fluid collection best seen in the right frontal-parietal region that extends all the way posteriorly around the brain and that extends medially along the falx.

The diagnosis was a right-sided and interhemispheric acute subdural hematoma.

Toddler after a motor vehicle accident

CT of subarachnoid hemorrhage, intraventricular hemorrhage and diffuse cerebral edema — Axial CT without contrast of the brain shows acute hemorrhage around the Circle of Willis and brainstem (left) and in the posterior horns of the lateral ventricles bilaterally (right). There is also loss of the cortical sulci and basilar cisterns.

The diagnosis was post-traumatic subarachnoid hemorrhage and intraventricular hemorrhage and diffuse cerebral edema.

Unconscious school ager who fell from a tree

CT of diffuse cerebral edema — Axial CT with contrast of the brain shows diffuse brain swelling causing loss of the normal gyral pattern and compression of the ventricular system.

The diagnosis was diffuse cerebral edema.

Premature newborn baseline screening head ultrasound exam on day of life 7

US of intraventricular hemorrhage — Coronal (above left), left sagittal (above middle) and right sagittal (above right) US of the head shows a round echogenic focus in the left germinal matrix. There was also an echogenic focus in the occipital horn of the left lateral ventricle (not provided). The ventricular system was normal in size. Followup exam from 2 weeks later (below) shows interval decrease in size and cavitation of the echogenic foci in the left germinal matrix and occipital horn of the left lateral ventricle. The ventricular system is minimally increased in size.

The diagnosis was left grade II neonatal intraventricular hemorrhage.

Preschooler with right facial swelling

CT and MRI of first branchial cleft cyst — Axial CT with contrast of the face (above) shows a low density, poorly circumscribed lesion with faint rim enhancement expanding the right parotid gland. Inflammatory changes are noted in the adjacent subcutaneous tissues. Axial T2 MRI of the face from 7 months later (below left) shows areas of oval high signal intensity weaving in and out of the plane of the image representing a tract from the posterior aspect of the right parotid gland to the right external auditory canal which on axial DWI MRI (below right) also shows high signal intensity representing diffusion restriction in the tract.

The diagnosis was a parotid abscess due to an infected first branchial cleft cyst.

School ager with a bump on the right side of the face

CT of odontogenic keratocyst in Gorlin syndrome — Axial (above), coronal (below left) and sagittal (below right) CT without contrast of the face shows a lytic, expansile lesion in the right maxilla displacing the second right premolar tooth anterolateraly. There was no bone destruction or associated soft tissue mass.

The diagnosis was an odontogenic keratocyst in a patient with Gorlin syndrome.

Premature newborn with lethargy

US of intraventricular hemorrhage grade III — Coronal US of the brain shows echogenic material within the bilateral dilated lateral ventricles.

The diagnosis was neonatal intraventricular hemorrhage grade III.

Premature newborn with intracranial hemorrhage on ultrasound

MRI of neonatal intraventricular hemorrhage Grade I — Coronal T1 MRI with contrast of the brain (left) shows an enhancing lesion in the right germinal matrix that is of low signal intensity on gradient echo (right). There was no evidence on hemorrhage in the lateral ventricles.

The diagnosis was right neonatal intraventricular hemorrhage Grade I.

Newborn with a nuchal cord

CT and MRI of hypoxic ischemic encephalopathy — Axial CT without contrast of the brain (above) shows diffuse cerebral edema causing loss of the gray matter white matter junction. Axial T1 without contrast (middle left), FLAIR (middle middle) and T2 (middle right) MRI several days later show developing laminar necrosis. Diffusion weighted imaging (below) shows diffusion restriction throughout the gray matter, white matter, and basal ganglia.

The diagnosis was severe hypoxic ischemic encephalopathy.

Unconscious teenager after ATV accident

CT of cerebral contusion — Axial CT without contrast of the brain (left) shows a subgaleal hematoma anteriorly along with pneumocephalus and multiple areas of high density in the frontal lobes. Examination of the bone windows at the same level (right) shows multiple non-depressed fractures of the frontal bone.

The diagnosis was cerebral contusion.

Infant with difficulty with nose breathing when the left nostril is occluded

CT of membranous choanal atresia — Axial CT without contrast of the face shows thickening and bowing of the vomer to the right resulting in narrow right choana.

The diagnosis was membranous right choanal atresia.

Newborn with a very small jaw

3D CT of Pierre Robin syndrome — 3D CT without contrast of the face shows micrognathia.

The diagnosis was Pierre Robin syndrome.

Infant who cannot have a nasogastric tube passed through either nare

CT of choanal atresia — Axial CT without contrast of the face shows thickening and bowing of the vomer bilaterally resulting in narrow choana bilaterally.

The diagnosis was bilateral choanal atresia.

Newborn who cannot have a nasogastric tube passed through the left nares

CT of left choanal atresia — Axial CT without contrast of the maxillofacial bones shows thickening and bowing of the vomer to the left resulting in a narrow left choana.

The diagnosis was left choanal atresia.

Infant who is status post cardiac arrest

CT of hypoxic ischemic encephalopathy and interhemispheric subdural hematoma in child abuse — Axial CT without contrast of the brain shows decreased density of the cerebrum when compared to the density of the cerebellum. There is also loss of gray matter-white matter differentiation and effacement of the cerebral sulci and the basal cisterns. There is linear increased density present along the entire falx.

The diagnosis was hypoxic ischemic encephalopathy resulting in diffuse cerebral edema and an and interhemispheric subdural hematoma in a child abuse patient.

Toddler with left hearing loss

CT of acoustic neuroma — Axial CT without contrast of the temporal bones shows the left internal auditory canal (right) is smoothly expanded and much larger than the right internal auditory canal (left). This enlargement of the left internal auditory canal corresponded to the location of an enhancing mass within it on an MRI of the brain performed with contrast from an outside institution.

The diagnosis was left acoustic neuroma.

Extremely premature newborn now 2 months old

MRI of retinopathy of prematurity — Axial T2 MRI without contrast of the brain shows small orbits bilaterally. Heterogeneity of the vitreous humor could not be assessed for on the other sequences due to patient motion.

The diagnosis was bilateral microphthalmia due to retinopathy of prematurity.

Preschooler with difficulties with vision

MRI of macrophtalmia and optic pathway glioma in neurofibromatosis type I — Axial (above) and coronal (below) T2 MRI without contrast of the brain shows the left globe is larger than the right globe. The optic nerves bilaterally are thickened and tortuous.

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

Preschooler with seizures

CT and MRI of oligodendroglioma — Axial CT without contrast of the brain (above left) shows a right parietal ill-defined subcortical hypodensity. Axial (above right) and coronal (below right) T2 MRI of the brain show right parietal subcortical hyperdensities with associated cortical thickening that on axial T1 MRI with contrast (below left) shows minimal enhancement.

The diagnosis was oligodendroglioma.

Teenager with new onset seizure

CT and MRI of glioblastoma — Axial CT without contrast of the brain (above left) shows a hypodense, ill-defined, infiltrative mass centered in the left basal ganglia that contains coarse calcifications. Axial T2 (above right), T1 without contrast (below left) and T1 MRI with contrast (below right) of the brain show the mass to be heterogenous in nature and to have some heterogenous areas of enhancement.

The diagnosis was glioblastoma.

Teenager with back pain and lumbar scoliosis for 1 year

MRI of ganglioglioma of the spinal cord — Sagittal T1 (above left) and T2 (above middle) MRI of the spine show an intramedullary tumor of the spinal cord extending from T10 to T12 that on sagittal T1 MRI with contrast (above right) shows heterogenous enhancement. Axial T2 MRI (below) better demonstrates the cord expansion caused by the tumor.

The diagnosis was ganglioglioma of the spinal cord in a patient with painful scoliosis.

Toddler with a nasal lesion

MRI of nasal dermoid — Sagittal T1 MRI without contrast of the face (left) shows a small round lesion of high signal intensity at the tip of the nose which on sagittal T1 MRI with contrast and fat suppression (right) is of low signal intensity (fat suppressed) and to have no enhancement. There was no intracranial connection.

The diagnosis was nasal dermoid.

Toddler with new onset seizure

MRI of congenital lymphocytic choriomeningitis — Axial gradient echo MRI of the brain (above) show bilateral posterior periventricular punctate hypodensities felt to represent calcifications. Axial FLAIR MRI (below) show areas of patchy increased signal bilaterally in the periventricular white matter and in the subcortical white matter.

The diagnosis was congenital lymphocytic choriomeningitis.