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.

Infant with enterocolitis

Gross pathological image of Hirschsprung disease — Pathological image shows a narrow caliber rectum and sigmoid colon (to the lower right) until a transition zone is encountered in the caliber of the colon (in the middle right) at which point the caliber of the colon is dilated all the way back to the hepatic flexure (upper left). The caliber of the ascending colon, appendix (middle left) and terminal ileum (lower left) are normal.

The diagnosis was Hirschsprung disease with a transition zone in the sigmoid colon.

Premature newborn with respiratory distress on a ventilator

Gross pathology image of pulmonary interstitial emphysema — Gross pathological image of the right lung shows bubbles of air throughout the pulmonary interstitium of the lung.

The diagnosis was pulmonary interstitial emphysema in a patient with respiratory distress syndrome.

Newborn with prenatal ultrasound that showed marked bilateral hydroureteronephrosis

Clinical image of prune belly syndrome / Eagle Barrett syndrome — Clinical image shows a small thorax, a bulging abdomen due to hypoplastic abdominal wall musculature, and bilateral undescended testicles.

The diagnosis was Prune Belly Syndrome.

Toddler with an abdominal mass

Gross pathological image of Wilms tumor — Gross pathological image shows a whitish-tan mass with areas of hemorrhage and necrosis arising from the lower pole of the kidney. Note the compression of the adjacent renal tissue which manifests itself on imaging as the renal “claw” sign.

The diagnosis was Wilms tumor.

Toddler with abdominal distension after gastrojejunostomy tube placement 2 days ago

Surgical image of duodenal perforation — Surgical image shows the forceps within a hole in the fourth portion of the duodenum.

The diagnosis was duodenal perforation due to gastrojejunostomy tube placement.

Infant with abnormal facies and congenital heart disease

Surgical image of absent thymus in DiGeorge syndrome — Pathologic image shows near-complete absence of the thymus.

The diagnosis was DiGeorge syndrome

Teenager with pleuritic chest pain

Pathological image of Ewing sarcoma of the rib — Pathological image shows a tumor which was brown and grossly necrotic and was seen to be located predominantly in the soft tissues and not in the rib.

The diagnosis was Ewing sarcoma.

Newborn with an anterior abdominal wall defect

Clinical image of Pentalogy of Cantrell — Clinical image shows the umbilical cord entering an omphalocele sac. The apex of the heart can be seen under the superior portion of the sac. The upper portion of the heart is covered by skin but the sternum is split.

The diagnosis was Pentalogy of Cantrell.

Newborn with an anterior abdominal wall defect on prenatal ultrasound

Surgical image of gastroschisis — Surgical image shows the abdominal wall defect with stomach and small bowel protruding out of the abdomen, with no surrounding membranous sac.

The diagnosis was gastroschisis.