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

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

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.

Teenager with a painful lump after bumping his shin 1 year ago

Gross pathological image of osteosarcoma — Gross pathological image of the tibia shows an aggressive bone lesion with cortical bone destruction and extensive periosteal reaction.

Newborn with a large soft tissue mass on the back

Clinical image of infantile fibrosarcoma — Clinical image shows a large mass in the upper right back with overlying skin necrosis.

The diagnosis was infantile fibrosarcoma.

School ager female with abdominal pain and an abdominal mass

Surgical image of ovarian dysgerminoma causing ovarian torsion — Surgical image (above) shows a mass arising from the left ovary. Surgical image (below) shows the left adnexal pedicle to be twisted in the center of the image. The mass and the left ovary and the fallopian tube were found to be torsed.

The diagnosis was ovarian dysgerminoma causing ovarian torsion.

Preschooler with a palpable midline abdominal mass

Surgical image of rhabdomyosarcoma of the bladder — Surgical image shows the mass (between the surgeon’s fingers) to be extraperitoneal in location, originating from the left posterior aspect of the dome of the bladder. The mass did not appear to invade any normal structures except where it originated in the bladder, which is along the inferior edge of the image.

The diagnosis was rhabdomyosarcoma of the bladder.

Female infant with a right ovarian cyst on prenatal ultrasound and an incidental abdominal calcification noted on a CXR

Surgical image of ovarian torsion — Surgical image shows a large circular and soft mass that was adherent to, but not invading, the hepatic flexure, omentum, and distal ileum and which was no longer connected to any pelvic structures. There was no ovarian tissue in the right adnexa. The left ovary was normal.

The diagnosis was ovarian torsion that most likely occured in-utero.

Toddler with a right-sided abdominal mass

Gross pathological image of neuroblastoma — Gross pathological image with the aorta in the midline cut open shows a large mass arising from the right adrenal gland, which displaces the right kidney inferiorly and which crosses the midline and encases the aorta.

The diagnosis was neuroblastoma of the right adrenal gland.

Teenager with bloody diarrhea

Pathological image of colonic pseudopolyps in ulcerative colitis — Pathological image of the colon shows colonic pseudopolyps.

The diagnosis was ulcerative colitis.

School ager with appendectomy 3 months ago, now with abdominal pain and vomiting

Surgical image of small bowel obstruction due to abdominal adhesions — Surgical image shows dilated and congested loops of small intestine in the upper right corner and normal sized decompressed loops of small bowel adjacent to them. A volvulus was noted at the level of the terminal ileum, caused by adhesions from the cecum to the small bowel, forming a closed loop obstruction that was causing bowel wall congestion.

The diagnosis was small bowel obstruction due to abdominal adhesions.

School ager who fell off his bike and has abdominal pain

Surgical image of small bowel perforation — Surgical image shows an ileal perforation with the forceps placed through the perforation.

The diagnosis was small bowel perforation secondary to bowel trauma

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 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.