School ager with respiratory distress

CXR of pulmonary alveolar proteinosis — CXR AP shows bilateral diffuse and symmetrical interstitial infiltrates which are miliary in appearance.

The diagnosis was pulmonary alveolar proteinosis.

Preschooler with chronic respiratory distress and a long-standing abnormal CXR

CXR and CT of chronic airway foreign body in the form of a mucous plug — CXR AP and lateral (above) show an opacity in the left upper lobe that was stable over several months. Coronal CT with contrast of the chest (below) shows complete atelectasis of the left upper lobe. There is a soft tissue density present in the lumen of the left mainstem bronchus interrupting the continuity of the left mainstem bronchus. At bronchoscopy this was found to be a very thick mucous plug.

The diagnosis was chronic airway foreign body due to an impacted mucous plug.

Toddler who was seen to swallow something

AXR of gastrointestinal foreign body in the form of ingested rare earth magnets — AXR AP shows 13 small round radiopaque objects that are joined together in a chain.

The diagnosis was gastrointestinal foreign body in the form of a chain of rare earth magnets.

Teenager with syncope

CT of supratentorial astrocytoma — Axial CT without contrast of the brain shows a low density mass in the region of the pineal gland and left thalamus that has a punctate area of high density within it representing either calcification or hemorrhage. The mass is having mass effect on the third ventricle resulting in obstructive hydrocephalus and transependymal flow of cerebrospinal fluid.

The diagnosis was supratentorial astrocytoma.

School ager with abnormal appearing forearms

Radiograph of Madelung deformity — AP radiograph of the left forearm (left) shows shortening and bowing of the radius and positive ulnar variance. AP radiograph of the right forearm (right) shows shortening and bowing of the radius and negative ulnar variance.

The diagnosis was bilateral Madelung deformity.

Preschooler with abdominal pain

CT and ultrasound of a simple renal cyst — Axial (above left) and coronal (above right) CT with contrast of the abdomen show a round low density lesion in the upper pole of the right kidney. Sagittal US of the right kidney (below) shows an anechoic lesion in the upper pole of the right kidney that has a thin wall and no internal septations or calcifications.

The diagnosis was simple renal cyst.

School ager with respiratory distress which has not responded to medical therapy

CXR of carcinoid tumor of the chest — CXR AP and lateral show a dense consolidation in the right middle lobe.

The diagnosis was carcinoid tumor of the lung.

Teenager with chest pain

CT of spontaneous pneumothorax due to apical bleb — Axial CT with contrast of the chest at presentation (above) shows a large amount of air in the right pleural space which was subsequently treated with a chest tube. Coronal CT without contrast of the chest performed 1 week after presentation and after chest tube removal (below) shows a small bleb in the apex of the right lung.

The diagnosis was spontaneous pneumothorax due to an apical bleb.

Teenager with left facial pain

CT of dentigerous cyst — Axial (left) and coronal (right) CT without contrast of the face show an expansile cystic lesion of the left maxilla that contains a molar tooth within it.

The diagnosis was dentigerous cyst.

Teenager who is pregnant with new onset focal neurological deficits and ataxia

MRI of acute disseminated encephalomyelitis — Axial FLAIR MRI without contrast of the brain show multiple lesions in the centrum semiovale, periventricular white matter, splenium of the corpus callosum and white matter of the parietal and occipital lobes. There was no mass effect and no diffusion restriction associated with the lesions. No contrast was given as the patient was pregnant.

The diagnosis was acute disseminated encephalomyelitis.

Teenager who is a baseball pitcher with right shoulder pain

Radiograph of little leaguer shoulder — AP radiograph of the right shoulder (left) shows proximal humeral epiphysiolysis and physeal widening and juxtaphyseal osteopenia and mild metaphyseal sclerosis in the lateral aspect of the right proximal humeral physis. AP radiograph of the asymptomatic left shoulder (right) shows none of these findings.

The diagnosis was little leaguer shoulder.

Immune suppressed patient with odynophagia

UpperGI of candida esophagitis — AP images from an UpperGI show multiple longitudinally oriented lesions in the under-distended esophagus which are separated by normal mucosa and small round ulcers.

The diagnosis was candida esophagitis.

Toddler with a cough

CXR of mycoplasma pneumonia — CXR AP and lateral show bilateral diffuse bronchial wall thickening and subsequent interstitial infiltrates.

The diagnosis was mycoplasma pneumonia.

Teenager with a limp

Radiograph of osteofibrous dysplasia — AP (left) and lateral (right) radiographs of the lower extremities show in the tibial diaphysis multiple and too numerous to count eccentric expansile lucent lesions with bubbly and sclerotic borders which are without periosteal reaction.

The diagnosis was osteofibrous dysplasia.

School ager with a chronic cough and right shoulder pain

Radiograph of tuberculous osteomyelitis. — AP radiograph of the right shoulder shows a well circumscribed lucent lesion in the right humeral epiphysis. There is no periosteal reaction.

The diagnosis was tuberculous osteomyelitis.

Preschooler with right neck swelling

CT of parapharyngeal abscess — Axial CT with contrast of the neck shows a round low density fluid collection with a thin enhancing rim in the right parapharyngeal space. The right carotid artery and right internal jugular vein are narrowed in caliber and there is mass effect on the right side of the airway.

The diagnosis was right parapharyngeal abscess.

Teenager with pica

AXR of lead poisoning — AXR shows multiple punctate and linear radiopaque objects in the ascending colon.

The diagnosis was lead poisoning as the patient was subsequently found to have a high serum lead level.

Female preschooler with a urinary tract infection

VCUG showing spinning top urethra — AP image from a voiding cystourethrogram exam shows a non-obstructive ellipsoid-shaped dilation of the posterior urethra just distal to internal urethral sphincter.

The diagnosis was spinning top urethra.

Preschooler with anemia and a palpable epigastric mass

CT of trichobezoar — Coronal (above) and axial (below) CT with contrast of the abdomen show the stomach distended by a large mass that has a swirled appearance and that fills the entire stomach and the duodenal bulb.

The diagnosis was trichobezoar that after removal was found to have caused a gastric ulcer which eroded into the liver.

Toddler with a whooping-sounding cough

CXR of pertussis pneumonia — CXR AP shows bilateral lung hyperexpansion with bilateral perihilar infiltrates that blur the border of the heart, resulting in the heart border having a shaggy appearance.

The diagnosis was pertussis pneumonia.

Newborn who developed an episode of cardiac decompensation

CXR of pericardial effusion due to catheter perforation into pericardial space — CXR AP obtained after left subclavian line placement (above) shows the tip of the line in the right atrium. CXR AP obtained 3 days later during the episode of cardiac decompensation (below) shows interval enlargement of the cardiac silhouette. ECHO showed the subclavian line had perforated into the pericardial space resulting in a hemopericardium.

The diagnosis was subclavian venous catheter malfunction due to it perforating into the pericardial space resulting in a pericardial effusion.

Teenager with no history of esophageal surgery who is having repeated food bolus impactions in the esophagus

CT and upper GI of eosinophilic esophagitis — Axial CT without contrast of the chest (above) shows posterior to the trachea a dilated proximal esophagus due to food being impacted within it. AP (below left) and lateral (below right) images from an upper GI exam after the food bolus was removed from the esophagus show multiple ring-like narrowings encircling the proximal esophagus. The remainder of the esophagus was unremarkable.

The diagnosis was eosinophilic esophagitis.

Newborn whose mother was exposed to cytomegalovirus during pregnancy

US of cytomegalovirus encephalitis — Coronal US of the brain (above) shows large septated cysts in the germinal matrix (germinolysis) bilaterally along with multiple periventricular echogenic foci just lateral to the anterior horns of the lateral ventricles bilaterally representing periventricular calcifications. Left sagittal (below left) and right sagittal (below right) US show branching linear echogenicities in the basal ganglia respresenting lenticulostriate vasculopathy.

The diagnosis was cytomegalovirus encephalitis.

School ager with foot pain

Radiograph of Kohler disease — AP radiograph of the foot shows sclerosis and fragmentation of the tarsal navicular bone.

The diagnosis was Kohler disease.

Infant with a duplicated right kidney

VCUG of ectopic ureterocele and urachal diverticulum — Lateral image from a voiding cystourethrogram exam shows a round lucency / filling defect near the trigone of the bladder. There is also contrast filling a blind ending tubular tract at the dome of the bladder.

The diagnosis was duplicated kidney with ectopic ureterocele along with a urachal diverticulum.