School ager with nausea and vomiting

US and MAG3 nuclear medicine scan of orthotopic ureterocele — Transverse US of the bladder (above left) shows a round cystic lesion in the base of the bladder. Sagittal US of the bladder (above right) shows to the left of the image an extremely dilated left ureter and to the right of the image again the round cystic lesion in the base of the bladder. Sagittal image of the left renal fossa (below left) shows non-visualization of the left kidney. Nuclear medicine MAG3 scan (below right) shows a normal right kidney, non-visualization of the left kidney, and a round photopenic defect in the bladder.

The diagnosis was left non-functioning kidney with left hydroureter and a left orthotopic ureterocele.

Teenager with right lower extremity swelling

MRI of pediatric cellulitis of the lower extremity — Two non-contiguous axial T2 MRI images of the right lower extremity show diffuse circumferential high T2 signal in the subcutaneous tissues and along the deep fascial plane. There were no abscesses seen.

The diagnosis was cellulitis of the lower extremity.

Teenager with fever and odynophagia

CT of intratonsillar abscess of right palatine tonsil — Axial (left), coronal (above right) and sagittal (below right) CT with contrast of the head and neck show a low density fluid collection in the right palatine tonsil that is surrounded by a thin enhancing rim of tissue. The airway is widely patent.

The diagnosis was intratonsillar abscess of the right palatine tonsil.

Newborn with bloody stools

AXR of pneumatosis intestinalis in necrotizing enterocolitis — AXR AP shows curvilinear appearing air in the wall of the descending colon.

The diagnosis was pneumatosis intestinalis of the descending colon in a patient with necrotizing enterocolitis.

School ager who fell on an outstretched hand and now has elbow pain

Radiograph of pediatric capitellum fracture of the elbow — AP (left), oblique (middle) and lateral (right) radiographs of the elbow show a fracture line through the capitellum which is displaced anteriorly and superiorly along the humerus which is best shown on the lateral radiograph, which also shows elevation of the anterior and posterior fat pads of the elbow.

The diagnosis was elbow fracture of the capitellum.

Newborn with respiratory distress

CXR of pediatric Group B streptococcus pneumonia — CXR AP shows normal lung expansion with fine interstitial infiltrates bilaterally.

The diagnosis was Group B streptococcus pneumonia.

School ager with a ventriculoperitoneal shunt and a new headache

Radiograph of broken ventriculoperitoneal shunt tubing — AP radiograph of the skull (left) shows a break in the VP shunt tubing just above the right orbit. AXR (right) shows the remaining VP shunt tubing coiled in the pelvis.

The diagnosis was ventriculoperitoneal shunt malfunction in the form of broken shunt tubing.

Teenager after motor vehicle accident

CT of renal laceration and suspected ureter transection — Axial CT with contrast of the abdomen (above left) shows an extensive laceration of the left kidney with an associated low density retroperitoneal hematoma surrounding the left kidney. Delayed lower axial image from the same CT exam (below left) shows extravasation of high density IV contrast around the left psoas muscle. 3D CT urogram performed the next day (right) again shows massive extravasation of IV contrast medial to the left kidney with non-visualization of the left ureter suggesting ureteral transection. The right kidney and ureter are normal. However, a retrograde urogram performed the next day showed the left ureter was not transected which allowed placement of a left ureteral stent.

The diagnosis was left kidney laceration and suspected left ureteral transection which was not confirmed on a retrograde pyelogram exam.

Teenager with a soft tissue mass between the first and second digits of the hand

Radiograph and US of venous malformation of the hand — AP radiograph of the hand (above) shows a large round laminated appearing calcified phlebolith between the first and second digits of the hand. Transverse US of the area of calcification (below) shows two laminated appearing clots of varying age.

The diagnosis was vascular malformation of the hand in the form of a venous malformation.

Infant whose anterior fontanelle appeared to close prematurely

Radiograph and CT of Wormian bone in the anterior fontanelle — AP radiograph of the skull (left) shows a bone in the region of the anterior fontanelle. 3D CT without contrast of the skull (right) shows a Wormian bone in the anterior fontanelle.

The diagnosis was Wormian bones with a Wormian bone in the anterior fontanelle.

Premature newborn after umbilical venous catheter placement

US of TPNoma due to umbilical venous catheter malposition — CXR AP (above) shows the tip of the umbilical venous catheter projecting over the left portal vein. Transverse (below left) and sagittal (below right) US of the left lobe of the liver obtained 4 months later shows hyperechoic branching lesions in the liver which are felt to be calcifications in the distal branches of the portal veins due to long term direct injection of total parenteral nutrition into the distal branches of the portal veins rather than into the inferior vena cava.

The diagnosis was TPNoma due to umbilical venous catheter malposition in the left portal vein.

Preschooler with elbow pain after being tackled

Radiograph of ossification centers of the elbow ossifying out of their normal order — AP (left) and lateral (right) radiographs of the elbow show ossification of the capitellum and internal (medial) epicondyle. The radial head is not yet ossified. No fracture or fat pad elevation is seen.

The diagnosis was no fracture of the elbow as the ossification centers of the elbow are ossifying out of their normal order as normally the radial head should ossify before the internal (medial) epicondyle according to the CRITOE mneumonic.

Newborn with respiratory distress

CXR of transient tachypnea of the newborn — CXR AP on the first day of life (left) shows normal lung volumes with prominent interstitial infiltrates bilaterally in the lungs. CXR AP on the second day of life (right) shows interval resolution of the interstitial infiltrates.

The diagnosis was transient tachypnea of the newborn.

Teenager with a VP shunt with a new headache

Radiograph of broken VP shunt tubing — AP radiograph of the neck (above) shows the VP shunt catheter is broken at the level of the mid-neck. Axial CT without contrast of the brain obtained one year ago (below left) shows the tip of the VP shunt in the left lateral ventricle and the ventricular system to be decompressed. Current axial CT without contrast (below right) shows the tip of the VP shunt to be in the left lateral ventricle and interval development of dilation of the ventricular system.

The diagnosis was ventriculoperitoneal shunt malfunction in the form of broken shunt tubing causing interval development of hydrocephalus.

Newborn with a mass at the umbilicus

US of umbilical granuloma — Transverse (left) and sagittal (right) US of the umbilicus shows a round hyperechoic lesion with a hypoechoic rim near the umbilical stump.

The diagnosis was umbilical granuloma.

School ager with systemic lupus erythematosis with new left pleuritic chest pain

CXR of lupus pneumonitis — CXR AP (left) shows a fine interstitial infiltrate in the left lower lung that on the lateral CXR (right) is seen to be projecting over the spine.

The diagnosis was left lower lobe acute pneumonitis due to systemic lupus erythematosus.

Teenager with abdominal pain

MRI of schwannoma — AXR AP (above left) shows an incidental semi-circular left paraspinal mass next to the T10-T11 vertebral bodies. Axial T1 MRI without contrast of the thoracic spine (below left) shows an isointense round mass just to the left of the vertebral body. On axial T2 MRI (below center) the mass is hyperintense and on axial T1 MRI with contrast (below right) the mass enhances avidly and homogeneously. There was no spinal extension of the mass. On coronal T1 MRI with contrast (above right) the mass is again seen to be next to the T10-T11 vertebral bodies.

The diagnosis was schwannoma.

Teenager who had a Nissen fundoplication 3 days ago who cannot swallow water or medications

Upper GI of Nissen fundoplication wrap that is too tight — AP image from an UpperGI exam taken 15 minutes after the first swallow of contrast shows most of the contrast is still in the distal esophagus and only a small amount of contrast is in the stomach due to very slow emptying of the esophagus through the Nissen fundoplication into the stomach.

The diagnosis was Nissen fundoplication malfunction in the form of the Nissen fundoplication being too tight.

School ager who fell from the monkey bars and has wrist pain

Radiograph of Colles fracture — AP radiograph of the wrist (left) shows an extra-articular fracture of the distal radial metaphyseal region while the lateral (right) shows dorsal angulation and impaction of the distal fracture fragment without the involvement of the articular surface.

The diagnosis was Colles fracture.

Newborn with respiratory distress

CXR of transient tachypnea of the newborn — CXR AP on the first day of life (left) shows normal lung volumes with prominent interstitial infiltrates bilaterally in the lungs and a small right pleural effusion with fluid in the minor fissure of the right lung. CXR AP on the second day of life (right) shows interval resolution of the interstitial infiltrates with a small amount of pleural effusion remaining in the minor fissure of the right lung.

The diagnosis was transient tachypnea of the newborn.

School ager who is having difficulty using their central venous line

Central line injection of a fibrin sheath on a central venous catheter — AP image from a central line injection shows the distal part of the catheter is thicker than the rest of the catheter. Contrast was never seen to exit the tip of the catheter but instead was seen to exit the catheter from a position 2 cm above the tip of the catheter.

The diagnosis was central venous catheter malfunction in the form of a fibrin sheath along the distal catheter.

School ager with left scrotal pain

US of torsion of the appendix testis — Sagittal US of the left scrotum at presentation (above) shows a round lesion of heterogenous echogenicity superior to the left testicle. Sagittal US of the left scrotum 2 weeks later (below) shows the lesion has decreased in size and become uniformly echogenic.

The diagnosis was torsion of the appendix testis.

Toddler with an unusual appearing hand

Radiograph of symbrachydactyly — AP (left) and lateral (right) radiographs of the forearm and hand shows an absence of all the bones in the hand. There are nubbins of soft tissue where the phalanges should be. The radius and ulna are bowed.

The diagnosis was symbrachydactyly.

Preschooler 1 year after medical and surgical treatment for a posterior fossa tumor

MRI of spinal drop metastases in medulloblastoma — Sagittal (left and middle) T1 MRI with contrast of the spine shows diffuse enhancement along the cerebellar folia and the anterior and posterior aspects of the entire spinal cord. Axial T1 MRI with contrast of the spine (right) shows the enhancement to be somewhat nodular in nature around the spinal cord.

The diagnosis was recurrent medulloblastoma resulting in drop metastases to the spinal cord.

School ager who had a Nissen fundoplication 5 years ago and is now retching

Upper GI of para Nissen herniation after Nissen fundoplication — AP (left) and lateral (right) images from an UpperGI exam show the impression of the Nissen fundoplication wrap on the superior border of the stomach beneath the diaphragm. However, part of the stomach has herniated through the Nissen fundoplication to a position above the diaphragm.

The diagnosis was Nissen fundoplication malfunction in the form of a para Nissen herniation.