Newborn with bilious vomiting and a double bubble sign on AXR

Surgical image of duodenal atresia — In the operating room the duodenum was seen to taper between its second and third portions. A nasogastric tube could not be advanced past this area of tapering. There appeared to be a membrane obstructing the duodenum at this point. A duodenotomy was performed which confirmed the presence of a thick membrane completely obstructing the duodenum. Bile was seen above and below this membrane. The bile was coming from one papilla above the membrane and one papilla below it. Surgical image shows the superior retractor distracting the proximal duodenum and the inferior retractor distracting the distal duodenum. The obstructing membrane is seen between the retractors. The obstructing membrane was then incised.

The diagnosis was duodenal atresia.

Teenager with crampy abdominal pain and vomiting

Gross pathological image of Chron disease — Gross pathological image shows a normal cecum and appendix (right of image) and a stricture at the terminal ileum (middle of image), which is thickened. The terminal ileum is ulcerated with pseudopolyp formation at the stricture. Histopathology showed transmural inflammation of the terminal ileum with granuloma formation and ulceration.

The diagnosis was Crohn Disease.

Toddler with stridor since birth

Surgical image of right aortic arch with aberrant left subclavian artery — Surgical image taken through a left thoracotomy shows a blue vessel loop around the ligamentum arteriosum which was compressing the esophagus posterior to it. The red vessel loops are around the right aortic arch (on the right) and the left subclavian artery (on the left). The vascular ring was subsequently divided by division of the ligamentum arteriosum. The vascular ring then sprang open dramatically, relieving its compression upon the esophagus.

The diagnosis was right aortic arch with aberrant left subclavian artery and ligamentum arteriosum forming an incomplete vascular ring.

Newborn with abdominal distension after placement of a nasogastric tube

Surgical image of gastric perforation — Surgical image shows the surgical forceps in the center of the image delineating the size of the hole in the antrum of the stomach.

The diagnosis was gastric perforation.

Newborn with respiratory distress

Gross pathological image of asphyxiating thoracic dystrophy — Post-mortem gross pathological image shows an extremely small thorax due to shortened ribs, particularly when compared to the size of the abdomen.

The diagnosis was asphyxiating thoracic dystrophy.

Newborn who is lacking a cranial vault on physical exam

Pathological image of anencephaly — Post-mortem gross pathological image shows flattening of the top of the skull due to the absence of a cranial vault.

The diagnosis was anencephaly.

Infant with choking with feeding

Surgical image through a thoracotomy incision (left) shows blue vessel loop around an aberrant left subclavian artery arising from a Kommerell diverticulum. Black suture loop is around a patent ductus arteriosus that was noted to extend from the Kommerell diverticulum and completed a vascular ring which was compressing the esophagus posterior to it. Surgical image (right) with the patent ductus arteriosus mobilized off the esophagus which is between the tips of the hemostat show the esophagus now resorting to its normal caliber.

The diagnosis was right aortic arch with aberrant left subclavian artery and patent ductus arteriosus forming a complete vascular ring.

Infant with biphasic stridor that is most pronounced over the upper trachea

Surgical image of double aortic arch — Surgical image through a left posterolateral thoracotomy shows the red vessel loops around the double aortic arch and the blue vessel loops around the ligamentum arteriosum. The posterior aortic arch was divided, causing an impressive release of the ring with the 2 ends of the posterior arch separating by 2 to 3 centimeters. The ligamentum arteriosum was then divided.

The diagnosis was double aortic arch.

Newborn with an anterior chest wall defect including a split anterior half of the sternum, an omphalocele and a thoracoabdominal ectopic cordis

Surgical image of Pentalogy of Cantrell — Surgical image after the omphalocele sac was excised shows the apex of the heart (superiorly) and the liver (inferiorly). The pericardium was intact. The diaphragm was intact. The omphalocele was closed by approximating the abdominal fascia. The heart was covered with skin.

The diagnosis was Pentalogy of Cantrell.

Teenager with a chest wall deformity

Clinical image of pectus excavatum — Clinical image shows a marked concavity of the chest wall.

The diagnosis was pectus excavatum.

Newborn with congestive heart failure

Gross pathological image of infradiaphragmatic total anomalous pulmonary venous return — Gross pathological image shows the pulmonary veins joining into a common vein which descends through the diaphragm and which drains into the main portal vein within the liver.

The diagnosis was infradiaphragmatic total anomalous pulmonary venous return.

Newborn with abnormal kidneys and oligohydramnios on prenatal ultrasound

Clinical image of Potter syndrome due to pulmonary hypoplasia — Clinical image shows a flattened nose, recessed chin, prominent epicanthial folds and low set of abnormal ears.

The diagnosis was Potter syndrome due to pulmonary hypoplasia.

Newborn with respiratory distress

Gross pathological image of right pulmonary agenesis — Gross pathological image shows a normal appearing left mainstem bronchus and left upper lobe and left lower lobe. There is complete absence of the right mainstem bronchus and right lung.

The diagnosis was right pulmonary agenesis.

Preschooler with recurrent respiratory infections

Histopathological image of congenital pulmonary airway malformation — Histopathological image of H&E stained section shows dilated “alveolar” spaces lined by a combination of both respiratory and mucus-secreting epithelium.

The diagnosis was congenital pulmonary airway malformation.

Preschooler with recurrent respiratory infections

Surgical image of congenital pulmonary airway malformation — Surgical image shows multiple cystic lesions in the right upper lobe. The right middle and right lower lobes were normal.

The diagnosis was congenital pulmonary airway malformation.

Toddler with progressive respiratory distress

Histopathological image of congenital lobar emphysema — Histopathological image of H&E stained section shows the dilated but normally formed alveoli (on the left) separated by less expanded alveoli in a small adjacent lobe (on the right).

The diagnosis was congenital lobar emphysema.

Toddler with progressive respiratory distress

Gross pathological image of congenital lobar emphysema — Gross pathological image shows a distended and emphysematous right upper lobe with focal areas of hemorrhage and subpleural bullae.

The diagnosis was congenital lobar emphysema.

Toddler with progressive respiratory distress

Clinical image of congenital lobar emphysema — Clinical image shows a hyperexpanded right hemithorax when compared to the left hemithorax.

The diagnosis was right-sided congenital lobar emphysema.

Newborn with a mass in the left chest on prenatal ultrasound

Gross pathological image of congenital diaphragmatic hernia — Gross pathological image shows the heart and great vessels flipped superiorly, revealing an extremely hypoplastic left lung. The right lung is also somewhat hypoplastic in size.

The diagnosis was left-sided congenital diaphragmatic hernia.

Teenager with an anterior chest wall deformity

Clinical image of pectus excavatum — Clinical image shows marked depression of the sternum in the midline of the chest.

The diagnosis was pectus excavatum.

Toddler with a lesion on the first toe

Clinical image of soft tissue hemangioma of toe — Clinical image shows a large, raised, red, coarse lesion involving almost the entire first toe.

The diagnosis was soft tissue hemangioma.

Newborn with a neck mass

Clinical image of lymphatic malformation — Clinical images (above) show a large bilateral neck and facial mass which was demonstrated by transillumination (below) to be cystic.

The diagnosis was lymphatic malformation.

Infant with a small sinus located at the right sternocleidomastoid muscle that had expressed some secretions

Clinical image of second branchial cleft sinus — Clinical images show a punctate cyst at the anterior border of the right sternocleidomastoid muscle (above) that with some massaging is seen to emit fluid (below).

The diagnosis was a second branchial cleft sinus.

Preschooler with a midline neck mass causing discomfort

Clinical image of thyroglossal duct cyst — AP (above) and lateral (below) clinical images show a large mass in the midline of the neck.

The diagnosis was thyroglossal duct cyst.

Toddler with a barky cough

Endoscopic image of croup — Series of endoscopic images of the airway show persistent narrowing of the subglottic trachea.

The diagnosis was croup.