Premature newborn with abdominal distension and clinical deterioration

Surgical image of necrotizing enterocolitis — Surgical image shows the bowel was white and necrotic throughout its entire length from the duodenum to the colon. There was no salvageable bowel.

The diagnosis was total necrosis of the intestines due to necrotizing enterocolitis.

Toddler with an abdominal mass in the right upper quadrant

Surgical image of mesenchymal hamartoma — Surgical image shows a massive tumor in the left medial segment of the liver after it has been delivered. The left lateral segment of the liver and the right lobe of the liver appeared normal and this was confirmed by intraoperative ultrasound. The patient underwent a left medial segment hepatectomy.

Newborn infant of a diabetic mother who has failed to pass meconium

Clinical image of meconium plug — Clinical image shows a contiguous plug of meconium that was expelled by the patient after a water-soluble contrast enema.

Infant with non-bilious and bilious vomiting

Surgical image of Meckel's diverticulum — Surgical image shows shows multiple dilated loops of small bowel in the background with a sharp transition point seen in the center of the image in the terminal ileum where on its anti-mesenteric border a diverticulum is seen with an omphalomesenteric duct remnant coming off it. This remnant had been attached to the under surface of the umbilicus, serving as a fulcrum for a small bowel volvulus, resulting in a small bowel obstruction.

The diagnosis was Meckel’s diverticulum causing a small bowel volvulus and a small bowel obstruction.

Newborn with vomiting and a double bubble sign on prenatal ultrasound

Surgical image of jejunal stenosis — Surgical image shows the two retractors outlining a markedly dilated duodenum in the center of the image. The proximal jejunum is markedly stenotic where it joins to the duodenum at the duodenal-jejunal junction in the center of the image. The more distal jejunum is normal in caliber.

The diagnosis was jejunal stenosis.

Teenager with abdominal pain and vomiting with a narrowed terminal ileum

Gross pathological image of Chron's disease — Gross pathological image of the terminal ileum shows markedly thickened intestinal wall and adherent pericolonic fat (“fat-wrapping”).

The diagnosis was Crohn’s disease.

Newborn with vomiting and a palpable abdominal mass

Surgical image of duodenal duplication — Surgical image shows a cystic mass attached to the inner surface of the C-loop of the duodenum from just distal to the pylorus to slightly proximal to the region of the ampulla of Vater. The distal antrum is visible in the upper left corner of the incision and the gall bladder is visible in the right corner of the incision between the liver and the mass.

The diagnosis was duodenal duplication.

Newborn with failure to pass a nasogastric tube

Pathologic image of esophageal atresia — Pathological image taken from the posterior aspect of the specimen shows a dilated proximal esophageal pouch superiorly that abruptly transitions to a more narrow in diameter distal esophageal segment.

The diagnosis was esophageal atresia.

Newborn with failure to pass meconium

Surgical image of colonic atresia — Surgical images show numerous loops of small bowel which are dilated, thickened and inflamed along with an extremely dilated ascending colon which is at the lower part of the left image and to the left side of the right image. An area of atresia was identified at approximately the hepatic flexure. The downstream colon (not shown) had the appearance of a microcolon. On the right image, the forceps are on the dilated appendix.

The diagnosis was colonic atresia near the level of the hepatic flexure.

Infant with 5 days of vomiting and abdominal distension who now has peritoneal signs and currant jelly stools

Surgical image of ileocolic intussusception — Surgical image shows an ileocolic intussusception extending into the mid ascending colon with a dusky terminal ileum (to the right) intussuscepting into the cecum (to the left). Note that the appendix (in the middle of the image) is intussuscepted with the ileum. The intussusception was reduced without great difficulty manually. No lead point was seen.

Newborn with a cystic abdominal mass on prenatal US

Surgical image of ileal duplication — Surgical images show the round mass arising from the mesenteric border of the ileum.

The diagnosis was ileal duplication.

Infant with respiratory distress, anemia, and an abdominal mass

Surgical image of inflammatory myofibroblastic tumor — Surgical image shows a mass with a large number of collateral blood vessels that was intimately associated to the terminal ileum and cecum with the appendix draped across the mass.

The diagnosis was inflammatory myofibroblastic tumor.

Infant with vomiting and a palpable olive

Surgical image of hypertrophic pyloric stenosis — Surgical image shows delivery of the pylorus which is thickened, firm and blanched as opposed to its normal small, soft and pink consistency.

The diagnosis was hypertrophic pyloric stenosis.

Newborn with polyhydramnios and a double bubble sign on prenatal US

Surgical image of duodenal atresia — Surgical image shows a massive fluid filled stomach (on the left) and duodenal bulb (on the right) which was found to contain over 400 cc of fluid.

The diagnosis was duodenal atresia.

Newborn with failure to pass meconium

Surgical image of ileal atresia — Surgical image shows a massively dilated distal ileum (to the left of the image) than then dramatically narrows in the center of the image.

The diagnosis was ileal atresia.

Teenager with paraplegia who uses an appendicovesicostomy for self-catheterization who now has abdominal distension and no stool for one week

Surgical image of cecal volvulus — Surgical image shows an extremely distended cecum twisted around the pateint’s appendicovesicostomy tract. The distal ileum was also extremely dilated.

The diagnosis was cecal volvulus.

Young adult with recurrent pulmonary infections

Gross pathological image of bronchial atresia — Gross pathological image of a sectioned right middle lobe shows a dilated mucous filled airway (in white) distal to a focal area of an atretic bronchus.

The diagnosis was bronchial atresia.

Teenager with a chronic cough

Gross pathological image of bronchiectasis in cystic fibrosis — Gross pathological image of a sectioned lung shows marked dilation of the airways in the middle and lower lung with many of the dilated airways containing mucous within them.

The diagnosis was bronchietasis in cystic fibrosis.

Toddler with a right suprarenal mass

Gross pathological image of extralobar pulmonary sequestration — Gross pathological images show a right-sided subdiaphragmatic / suprarenal mass similar in appearance to the lung above it (above left). When the aorta was opened (above right), the orifice of an arterial vessel supplying the mass was seen coming off of the aorta just above the tip of the upper hemostat on the right side of the aorta. The relationship of the feeding vessel off of the aorta to the mass is more clearly demonstrated on the specimen image (below).

The diagnosis was a subdiaphragmatic extralobar pulmonary sequestration.

School ager with respiratory distress and an anterior mediastinal mass

Specimen radiograph of thymic teratoma / mediastinal teratoma — Specimen radiograph shows densely calcified rectangular structures in the resected thymic mass which turned out to be teeth.

The diagnosis was thymic teratoma.

Infant with respiratory distress

Gross pathological image of inflammatory myofibroblastic tumor — Gross pathological image shows a pale solid mass in the center of the lung.

The diagnosis was inflammatory myofibroblastic tumor.

Teenager with abdominal pain

Pathologic image of acute appendicitis with appendicoliths — Pathological image with the appendix opened longitudinally shows it to be grossly inflamed with two appendicoliths within the lumen of the appendix.

The diagnosis was acute appendicitis.

School ager with chronic inspiratory stridor

Gross pathology image of papillomas — Pathological image shows multiple white subglottic tracheal masses.

The diagnosis was multiple papillomas.

Newborn with failure to pass meconium

Clinical image of anorectal malformation / imperforate anus — Clinical image shows absence of the anal orifice. There is a good buttock cleft. There were no perineal or scrotal raphe fistula seen.

The diagnosis was anorectal malformation.

Preschooler with progressive respiratory distress

Surgical image of congenital lobar emphysema — Surgical image taken just after opening the right chest shows a very large and emphysematous right upper lobe which was allowed to herniate out through the incision, thus decompressing the other intrathoracic structures. The patient’s respiratory status improved immediately. The tip of the normal right middle lobe can be seen under the over inflated right upper lobe.

The diagnosis was congenital lobar emphysema.