Anda di halaman 1dari 708

Sagittal cranial US demonstrates

periventricular calcification.

Congenital CMV.

Axial C-CT of the head


demonstrates intracranial
calcification, primarily
periventricular.

Congenital CMV.

Sagittal cranial US shows


branching echogenicity in the
basal ganglia.

Congenital CMV with


lenticulostriate vasculopathy.

Axial C-CT of the head


demonstrates periventricular
calcification and lissencephaly.

Congenital CMV.

Axial C-CT of the head


demonstrates periventricular
calcification.

Infant with LCM virus


(appearances are
indistinguishable from CMV).

Axial C-CT of the head


demonstrates parenchymal
calcification.

Congenital toxoplasmosis.

Axial C-CT of the head


demonstrates diffuse low density
areas.

Congenital herpes simplex type II infection.

Axial T2W MR image


demonstrates right temporal lobe
edema.

Herpes simplex type II infection.

Axial C-CT of the head


demonstrates bilateral basal
ganglia calcification.

Congenital HIV infection

Axial C-CT of the head


demonstrates low density within
deep white matter.
Periventricular calcification is
due to coexistent CMV.

Congenital HIV infection with


leukoencephalopathy.

Postnatal axial C+CT image


shows brain destruction,
periventricular calcification and a
left-sided subdural hematoma.

Congenital CMV infection with


thrombocytopenia.

Axial C-CT scan shows left


cerebellar hypoplasia and
calcification.

f an infant with a history of Early


second trimester CMV infection.

Axial C-CT scan shows extensive


left hemisphere cortical dysplasia
and periventricular and
parenchymal calcifications

Congenital CMV infection.

Axial T2W MR image shows


fusiform aneurysmal dilation of
the left ICA and basilar arteries.

HIV vasculopathy.

Axial FLAIR image shows a


lacunar infarct in the left basal
ganglia.

HIV vasculopathy with lacunar infarct.

VCUG demonstrates bilateral


vesicoureteral reflux.

Grade V reflux bilaterally

VCUG demonstrates giant left


bladder outpouching.

Left bladder diverticulum.

VCUG demonstrates reflux


associated with outpouching.

Left bladder diverticulum with


left grade III reflux.

Coronal prenatal US images of a fetal


abdomen demonstrate bilateral
pelvicalyectasis.

Bilateral pelvicalyectasis.

Sagittal US shows thinning of the


lower pole of the right kidney.

Scarring of the lower pole of the


right kidney secondary to
longstanding reflux.

Oblique views from a VCUG are


performed to demonstrate the
ureterovesical junction which is
normally found at the junction of
the lower and midthird of the full
bladder.

Normal UVJ with grade I reflux

Oblique views from a VCUG are


performed to demonstrate the
ureterovesical junction which is
normally found at the junction of
the lower and midthird of the full
bladder.

Normal UVJ with grade I reflux.

RNC grade III reflux.

Grade III reflux.

Bilateral reflux.

Grade I reflux bilaterally.

Bilateral reflux.

Grade II reflux bilaterally.

Left reflux.

Left grade III reflux.

Left reflux.

Left grade V reflux.

VCUG with unilateral left reflux


and upper and lower pole
intrarenal reflux.

Left grade III reflux with intrarenal reflux.

C+CT shows wedge-shaped


underperfused foci.

Pyelonephritis.

Nuclear medicine DMSA shows a


focal upper pole defect
consistent with hypoperfusion.

Acute pyelonephritis.

VCUG shows rright grade III


reflux into the lower pole of a
duplex kidney. Left grade III
reflux into a single collecting
system. Note abnormal axis of
right collecting system giving a
clue that the upper pole has not
filled.

Duplication with reflux into the


lower pole systems.

VCUG shows bilateral lower pole


grade III reflux. The axis of the
kidneys is abnormal.

Duplication with reflux into the


lower pole systems.

VCUG shows bilateral UPJ


obstruction and reflux. (Dilute
refluxed contrast in both upper
poles.)

Bilateral UPJ obstruction and


grade V reflux.

- Plain X ray chest .


- Postero-anterior view.
- The patient is not well centralised.
- Costophrenic angles are free on both sides.
- Cardio-thoracic ratio increased about 70% denoting
cardiomegaly.
- Cardiophrenic angle on the left side is obtuse (left ventricle
dilatation).
- Straight left cardiac border (waist obliteration): mitralized
heart: dilated left atrium and
pulmonary artery.
- Bulging right cardiac border (right atrium dilatation).
- Increase pulmonary vascular markings (hilar congestion)
Cardiomegaly due to enlargement of left ventricle, left atrium,
pulmonary
artery and right atrium for differential diagnosis (most
probably due to :Rheumatic heart disease

- Plain X ray chest


- Postero-anterior view
- The patient is not well centralized
- Costophrenic angles are free on both sides
- Cardio-thoracic ratio increased about 70% in (1 and 2)
, 60 % in ( 3) denoting cardiomegaly
- Cardiophrenic angle on the left side is not visualized in
(1) obtuse in (2 , 3 ) denoting left ventricle dilatation)
- Prominent pulmonary conus (pulmonary artery
dilatation)
- Bulging right cardiac border (right atrium dilatation) in
1 & 2 (normal Rt border in 3)
- Increase pulmonary vascular markings (hilar
congestion)
Cardiomegaly due to enlargement of left ventricle, left
atrium, pulmonary artery and right atrium ( not in 3),
most probably due to :
Rheumatic heart disease

- Plain X ray chest - Postero-anterior view - The patient is not well


centralized
- Costophrenic angles are free on both sides- Cardio-thoracic ratio
increased about 70%
- Cardiophrenic angle on the left side is acute ( right ventricle
dilatation)
- Shelfing of the left cardiac border
- There is heterogeneous opacity in the middle and lower third of
the right lung (pneumonia)
overlapping most of the right cardiac border.
Cardiomegaly due to enlargement of Rt ventricle for differential
diagnosis
Right side pneumonia

- Plain X ray chest - Postero-anterior view - The patient is


well centralized
- Costophrenic angles are free on both sides- Cardiothoracic ratio increased about 70%
- Cardiophrenic angle on the left side is acute ( right
ventricle dilatation)
- Bulging of the right cardic border ( Rt atrium dilatation)
- The heart is globular in shape
- Pulmonary vascular markings are slightly increased
Generalized enlargement of cardiac chamber ( globular
shape heart)..

- Plain X ray chest - Postero-anterior view- The patient


is well centralized
- Costophrenic angles are free on both sides
- Cardiophrenic angle is acute? (may appear obtuse)
- Marked increase in the cardio-thoracic ratio about 85
% in (1) , 95% in (2)
denoting huge cardiomegaly .
- Symmetrical bulge of the left and right cardiac
borders
- The borders are very well defined (stenciled)
- Broad cardiac base (accumulation of fluid)
- Normal pulmonary vascular markings
Huge Cardiomegaly in the form of (flask shaped) most
probably due to
pericardial effusion

- Plain X ray chest - Postero-anterior view - The


patient is not centralized
- Costophrenic angles are free on both sides
- Cardio-thoracic ratio increased about 70%
- Cardiophrenic angle on the left side is acute
(right ventricle dilatation)
- Marked bulge of the right border (right atrium
dilatation)
- The base of the heart is wide ( TGA has narrow
base)
- Mild Increased in the pulmonary vascular
markings
Cardiomegaly due to enlargement of Rt
ventricle and Rt atrium

- Plain X ray chest - Postero-anterior view


- The patient is not centralized
- Costophrenic angles are free on both sides
- Cardio-thoracic ratio increased about 70%
- Cardiophrenic angle on the left side is acute (right
ventricle dilatation)
- Marked bulge of the right border (right atrium dilatation)
- The base of the heart is narrow
- In (1) : Increased pulmonary vascular markings and
heterogenous opacity in the upper
and middle zone of the right lung (pneumonia). In (2)
normal bronchovascular markings.
Cardiomegaly in the form of (Egg on side) most probably
due
transposition of
great arteries + pneumonia in 1

- Plain X ray chest


- Postero-anterior view
- The patient is not centralized
- Costophrenic angles are free on both sides
- Cardio-thoracic ratio is normal or mildly increased
- Cardiophrenic angle on the left side is acute
with uplifted apex(Rt ventricle hypertrophy)
- Exaggerated waist (pulmonary hypoplasia)
- Decreased pulmonary vascular markings(lung oligemia)
Coeur en saboau : boot shaped heart:
tetralogy of Fallot ??

- Plain X ray chest and abdomen


- Postero-anterior view
- The patient is not centralized
- Costophrenic angles are free on both sides
- Cardio-thoracic ratio is normal
- There is area of jet black translucency
surrounding the
cardiac shadow (air in the pericardial sac)
- Thin rim of Jet black translusceny seen on the
apex of left
lung pushing the lung medially (Left side
pneumothprax)
- Homogenous opacity on the Rt lung: white lung:
RDS
- Endotracheal tube is present in
Pneumopericardium RDS - left side
pneumothorax
(1)

Pneumopericardium
-RDS (2)
The same , but no
pneumothorax.
Right and left lung are
white

- Plain X ray chest and heart- Postero-anterior view


- The patient is centralized
- Costophrenic angles are free on both sides
- Cardio-thoracic ratio is normal
Abnormal site of the heart
. The heart lies on the right side
The cardiac apex is on the right side
. The left border is formed by right atrium while the
right one
is formed by pulmonary artery, left atrium and left
ventricle
- Abnormal position of the stomach and liver (gastric
air
bubbles on the right side while the liver shadow is on
the
left side)
Situs inversus totalis
-

- Plain X ray chest


- Postero-anterior view
- The patient is centralized
- The right (left ) costophrenic angle is
obliterated by homogenous opacity
occupying also all
the right ( left) hemithorax
- Shifting the mediastinum (the tracheal
air column and heart) to the opposite
side of the
lesion (left side) ( Rt side)
Right side (left side ) massive pleural
effusion

Plain X ray chest


- Postero-anterior view
- The patient is not centralized
- The left costophrenic angle is
obliterated by homogenous opacity
with concave upper
border rising to the axilla.
- Shifting the mediastinum (the
tracheal air column and heart) to the
opposite side of the
lesion (Rt side).
Left side moderate pleural effusion

- Plain X ray chest - Posteroanterior view- The patient is not


centralized
-The left and right costophrenic
angles are obliterated by
homogenous opacity with
concave upper border rising to
the axilla
- Central mediastinum
Bilateral pleural effusion

- Plain X ray chest and heart


- Postero-anterior view - The patient is
centralized
- Costophrenic angles are free on both
sides
- Central mediastinum
- There is heterogneous opacity
In (1) triangular in shape on the apical part
of the right lung
in (2) on the upper part of the right lung
(
)
in (3) on the upper lobe of the right lung
in (4) on the upper 2/3 of the right lung
Right side lobar pneumonia
corresponding to the infraclavicular area

- Plain X ray chest


- Postero-anterior view
- The patient is not centralized
- There is homogenous opacity
occupying all the (left hemithorax in
1,2,3) (the right
hemithorax in 4)
- The mediastinum (heart and tracheal
air column ) is shifted to the same
side of the lesion
Left side massive lung collapse (1,2,3)
- Right side massive lung collapse ( 4)

- Plain X ray chest and heart - Posteroanterior view - The patient is not
centralized
- Costophrenic angle on the left side is
obliterated by homogenous opacity with
transverse
horizontal upper border (fluid level). The
remaining part of the left hemithorax is jet
black
(air). In 2 the collapsed left lung appear as
homogenous opacity
- The heart and tracheal air column are
shifted to the opposite side the lesion(Rt
side

- Plain X ray chest and heart - Posteroanterior view - The patient is not
centralized
- Costophrenic angle on the Rt side is
obliterated by homogenous opacity with
transverse
horizontal upper border (fluid level). The
remaining part of the Rt hemithorax is jet
black
(air). The collapsed Rt lung appear as
homogenous opacity
- The heart and tracheal air column are
shifted to the opposite side the (Left side
lesion)

- Plain X ray chest - Postero-anterior viewThe patient is not centralized


- Costophrenic angles on both sides are free .
- The lower zone of the right lung in ( 1), the
upper zone of the right lung in (2) show a
cavity with well-defined thick outline
(abscess wall). The lower part of the lesion is
homogenous with transverse upper border
(fluid) while the upper part of the lesion is jet
black (air).
- The heart and tracheal air column is central
Right side lung abscess

- Plain X ray chest - Postero-anterior view- The patient is not centralized


- Costophrenic angle on the right side is obliterated by homogenous
opacity raising to the
axilla(pleural effusion).
- The middle and lower zone of the right lung show a cavity with welldefined thick outline
(abscess wall). The lower part of the lesion is homogenous with transverse
upper border
(fluid) while the upper part of the lesion is jet black (air).
- There is also heterogonous opacity on the lower lung third(pneumonia) In
2 and 3
with multiple thin wall cyst( pneumatoceles) in 3
- The heart and tracheal air column are central
(1) Rt side lung abscess and Rt side mild pleural effusion,
(2) Rt side lung abscess, Rt side mild pleural effusion and right side
pneumonia
(3) Rt side lung abscess, Rt side mild pleural effusion, right side
pneumonia and
pneumatoceles. In all most probably due to staph or Klebsiella pneumonia

- Plain X ray chest


- Postero-anterior view
- The patient is centralized
- Costophrenic angle on both sides are
free.
- The middle and lower lung zones of
the left lung show heterognous opacity
with multiple
(airspace surrounded by thin wall)
pneumatoceles
Left side pneumonia with
pneumatoceles, the cause is most
probably staphylococcal or Klebsiella

- Plain X ray chest


- Postero-anterior view
- The patient is centralized
- Costophrenic angle on the right side is obliterated by
homogenous opacity with upper
border raising to the axilla (pleural effusion)
- The middle and lower lung zones of the Rt lung show
heterogonous opacity with multiple
(airspace surrounded by thin wall) pneumatoceles
Rt side pneumonia with pneumatocele-right side pleural
effusion, the cause is
most probably staphylococcal or Klebsiella pneumonia

- Plain x ray chest and abdomen- post.anterior view - The patient is


centralized
- Costophrenic angles are free on both sides
- The right hemithorax shows jet black hypertranslucency with
absent bronchovascular
markings (pneumothorax) .The right lung appear as homogenous
opacity shifted against
the vertebral column(compression collapse)- Intercostals tube is
seen draining the
pneumothorax
- The left lung shows homogenous opacity , which may be the
original disease (RDS) or
may be lung collapse.
- Marked shift of the heart and tracheal air column to the left side
- The right copula of diaphragm and liver are shifted downwards
- In 2 (monitor electrodes are seen)
Right side pneumothorax with Rt lung compression collapse,

Left side lung collapse OR the primary pathology

- Plain x ray chest and abdomen- post.anterior view


- The patient is not centralized
- Costophrenic angles are free on both sides
- The right hemithorax shows jet black
hypertranslucency with absent bronchovascular
markings (pneumothorax) .The right lung appear
as homogenous opacity shifted against
the vertebral column(compression collapse)
- Marked shift of the heart and tracheal air column
to the left side
- The right copula of diaphragm and liver are
shifted downwards
Right side pneumothorax with right lung
compression collapse
(opposite side of the lesion)on

- Plain x ray chest and abdomen- post.anterior


view - The patient is not centralized
- Costophrenic angles are free on both sides
- The left hemithorax shows jet black hyper
translucency with absent bronchovascular
markings (pneumothorax) .The left lung appear
as homogenous opacity shifted against the
vertebral column(compression collapse)
- Marked shift of the heart and tracheal air
column to the right side(
Left side pneumothorax with left lung
compression collapse
opposite side of the lesion)

- Plain x ray chest and abdomen-post.anterior view


- The patient is centralized
- Costophrenic angles are free on both sides
- Left lung is hypertranslucent with diminished
broncovascular markings and wide intercostals
spaces (lobar emphysema).
The upper part of the left lung herniates
through the superior mediastinum.
- Rt lung : The upper part of the Rt lung shows
homogenous opacity with concave lower border
(collapse?), while its lower part is hypertranslucent
(compensatory emphysema)
-The heart shadow appears small, and shifted
with the tracheal air column to the right side
Left side congenital lobar emphysema
Right lung lobar collapse

- Plain x ray chest and abdomen-post.anterior view The patient is not centralized.
- Costophrenic angles are free on both sides.
- The left hemithorax shows heterogeneous opacities
present in the lower part simulating
pneumonia,intermingled with multiple radiolucent
cystic shadows simulating
pneumatocele (herniated intestinal loops).
-The heart and tracheal air column are shifted to the
opposite side of the lesion( right side).
- In 2 a lot of tubes are present ( Nasogastric
endotracheal umbilical catheter)
- In 3: lateral view : intestinal loops appear in the
retrosternal space pushing the heart backward
Left side congenital diaphragmatic hernia

X ray with contrast : barium


meal, enema and follow
through
- Herniated barium filled
intestinal loops in the right
hemithorax
- Shift of the heart and
tracheal air column to the left
side
(opposite side of the lesion )
-

- Plain x ray chest and abdomen


upright positio n
- Upper loops (upper 2/3) are
gaseous, dilated with multiple air
fluid levels
- Lower loops (lower 1/3) are not
gaseous
- Nasogastric tube is present in 1
- Rectal tube is present in 2
Intestinal obstruction

Plain X ray of the chest and


abdomen
upright position
- 2 large areas with air fluid
level
(one for stomach , the other
for the duodenum
- Lower part of the abdomen is
not gaseous
Duodenal atresia (double

Plain x ray chest and abdomen


upright position
Free air (hypertranslucent area)
n the peritoneal space
under the diaphragm above the liver .
in (2) the abdominal viscera are pushed
entrally by the air
The abdomen is distended with gasses
neumoperitoneum

- Lower GIT studies ( barium enema OR


gastrographin) showing obstruction of the
barium
- flow at the right hepatic flexure of the
colon with :. Characteristic coil spring appearance due
to passage of contrast between
intussuscptum and intussuscipiens in (1)
. Characteristic clow hand appearance in 2
and 3 due to interruption of contrast flow.
Intussusception

- Upper GIT studies ( barium OR


gastrographin)
- Markedly dilated stomach which appear
full of barium
- The narrow pyloric canal appear as
single line of barium
(string sign)
- The hypertrophied pylorus appears as
rounded translucent
shadow surrounding the narrow pyloric
canal
Congenital hypertrophic pyloric stenosis

- Plain X ray of the lower limbs


(ankle and knee joints)
- Wide joint space
- Cupping of the metaphyseal
area with frayed epiphyseal line
- Decreased bone density
- Bowing deformity of the tibia
and fibul
Active rickets??
a

- Plain X ray wrist joint


- Metacarpal bones show: . Loss of waist
. Thin cortex
. Wide medulla with mosaic
appearance
- Decreased bone density
( osteoprosis

Osteogenesis imperfecta??
- Marked decrease in the
one density
- Loss of differentiation
between medulla and
cortex
- Multiple fractures with
malunion
- Marked bone deformities

Hair on end appearance

6 month old child following a well-baby visit.

C+CT of the abdomen shows


bilateral renal masses.

Nephroblastomatosis.

6 yo girl with abdominal mass.

Longitudinal US shows the


sonographic "claw sign" created
by normal kidney enveloping the
tumor.

Wilms tumor.

Child with an abdominal mass.

C+CT showing left renal mass


with focal areas of enhancement.

Wilms tumor.

Abdominal mass.

C+CT showing right-sided renal


mass. "Claw" or "beak sign"
representing the normal kidney
describing acute angles with the
tumor proving that it originates
in the kidney.

Wilms tumor.

Child with abdominal mass.

C+CT shows large areas of tumor necrosis.

Wilms tumor.

18 mo child with abdominal mass.

C+CT scan shows a


predominantly cystic left Wilms
tumor. Normal Kidney.

Wilm's tumor.

Constipation.

C+T1W MRI(sagittal plane)


shows a heterogeneous pelvic
mass

Extrarenal Wilms.

23 mo with abdominal mass.

C+T1W MRI (coronal view)shows


a mass involving the left kidney.
Normal Kidney.

Cystic nephroma.

Infant with abdominal mass.

C+T1W MRI (coronal view)shows


a right renal mass with a
subcapsular "cyst" representing
hemorrhage and the mural
nodule. Normal Kidney.

Rhabdoid tumo

Teen with hematuria.

C+CT (sagittal MPR) showing a


solid right renal tumor .

Renal cell carcinoma.

Teen with hematuria.

Axial C+CT showing a solid right


renal tumor.

Renal cell carcinoma.

Child with abdominal mass.

C+CT scan of the abdomen shows


a mass of the right kidney.

Clear cell sarcoma.

Clear cell sarcoma of the kidney.

C-CT scan showing pulmonary nodule.

Metastatic clear cell sarcoma of


the kidney.

Frontal chest radiograph shows


an external Holter monitor. This
radiograph also shows ECG leads
externally. There is an NG tube
in the stomach and an ET tube at
T2. There is a temporary left
subclavian line in suboptimal
position, its tip too deep in the
right atrium abutting the inferior
wall of the right atrium. There is

Multiple tubes and lines and


external Holter monitor. Left
subclavian line has been
advanced too far.|

Frontal chest radiograph shows large ECMO


cannulae, one in the right atrium and one in
the right carotid artery. There is almost
total opacification of both lungs. The ET
tube is at T1. There is an esophageal
temperature probe in position behind the
heart, and an NG tube in the stomach. There
are two types of chest tubes, the image
guided pigtail on the right and left, and a
straight surgical chest tube on the left, less
well seen. An external ECG lead is visible on
the right.

Normal position of ECMO


catheters as well as multiple ICU
tubes and lines in good position.|

Frontal chest radiograph shows a


permanent pacemaker. The
power pack of this intracardiac
device is placed subcutaneously
over the anterior left side of
chest. The transvenous lead is
placed through the left
subclavian vein, runs across the
left innominate vein, down the
SVC with tip in the right

Permanent pacemaker in good


position.|

Frontal image from an UGI shows


an oblique indentation on the
esophagus.

Aberrant right subclavian artery


with normal left arch. The
presence of an aberrant right
subclavian artery usually does
not cause symptoms and is an
incidental finding.

Lateral image from an UGI


demonstrates a posterior
indentation.

Aberrant right subclavian artery.

Frontal view from an UGI shows


the duodenal bulb overlying the
spine and the duodenojejunal
junction lower and more midline
in position than normal.

Malrotation without midgut


volvulus.

Supine frontal view from an UGI


shows variation of normal
location of duodenojejunal
junction with first portion of
jejunum to the right of the spine.
It is most important to view and
document the "first pass" of
barium through the duodenal Cloop.

No malrotation.

Right anterior oblique view from


an UGI shows a normal pyloric
channel. The shape is smooth
and shaped like the letter "V".

Normal pylorus.

Right anterior oblique view from


an UGI shows mildly delayed
emptying of the stomach and
early, persistent constriction of
the pylorus.

Pylorospasm.

Right anterior oblique view from


an UGI shows a markedly
distended stomach with retained
secretions and a "string sign".

Pyloric stenosis.

Frontal view from a double


contrast UGI shows an elongated
"J-shaped" stomach and thin
delicate folds of the duodenum
and proximal jejunum

Normal shape of stomach in a


teen.

Frontal chest radiograph


demonstrates increased
pulmonary blood flow and a
mildly prominent main
pulmonary artery segment. Note
that the right interlobar
(descending) pulmonary artery
diameter is much greater than
the tracheal diameter.

ASD.

Frontal chest radiograph


demonstrates markedly
increased pulmonary blood flow,
cardiomegaly and marked
enlargement of the main
pulmonary artery segment.

ASD.

Frontal chest radiograph after


transcatheter placement of an
Amplatzer atrial septal occluder.

ASD.

Lateral chest radiograph


demonstrates increased
pulmonary blood flow and left
atrial enlargement that is seen
as posterior bulging of the
superior aspect of the posterior
heart border.

VSD.

Frontal chest radiograph


demonstrates increased
pulmonary blood flow,
cardiomegaly and left atrial
enlargement. Note the uplifted,
horizontal course of the left
mainstem bronchus secondary to
left atrial enlargement.

VSD.

Frontal chest radiograph


demonstrates cardiomegaly and
pulmonary edema. Note the
difficulty in defining the
pulmonary vascular pattern in
the presence of pulmonary
edema in an infant; however,
there is prominent size of the
interlobar pulmonary artery on
the right.

VSD.

Frontal chest radiograph


demonstrates lung
hyperinflation, increased
pulmonary blood flow, and
cardiomegaly.

Persistent AV canal.

Frontal radiograph demonstrates


increased pulmonary blood flow,
lung hyperinflation, and
cardiomegaly, with enlargement
of the right atrium, right
ventricle and the left atrium.

Complete AV canal.

Frontal projection from a left


ventriculogram demonstrates
the elongated and narrow left
ventricular outflow tract often
termed the "gooseneck
deformity".

Complete AV canal.

Frontal chest radiograph


demonstrates increased
pulmonary blood flow and a
ductus infundibulum. Note
diameter of the pulmonary
artery is over twice the size of
the associated bronchus in a
bronchovascular couplet in the
right lung base.

PDA.

Frontal chest radiograph taken 7


days after birth demonstrates
residual lung disease; however,
lung opacities were improving
and the patient was clinically
improving.

Frontal chest radiograph taken


11 days after birth demonstrates
increased pulmonary opacity and
interval increase in cardiac size
as the patient developed heart
failure.

Frontal chest radiograph


following left thoracotomy and
surgical ligation of the ductus
arteriosus shows a vascular clip
in the left mediastinum,
decreasing cardiac size and
improving pulmonary edema.
Note subtle left sided rib
deformities.

RDS and PDA.

Frontal chest radiograph


demonstrates increased
pulmonary blood flow,
cardiomegaly, and lung
hyperinflation. The infant
presented with congestive heart
failure

AP window.

Frontal chest radiograph


demonstrates increased
pulmonary blood flow, as well as
cardiomegaly.

Lateral chest radiograph in the


same child with a small AP
window better depicts the
cardiomegaly.

Small AP window.

The child was referred for evaluation


of fever,gait disturbance,visual loss
Patient Data:
Age: 8
Gender: Male
Race: Asian

MRI of the brain demonstrates confluent and


symmetric bilateral hyperintensities in white
matter of the parieto-occipital regions, corpus
callosum, acoustic radiation, inferior
colliculus.lateral leminiscus, pons, cerebellar
peduncle etc.

X-linked adrenoleukodystrophy (ALD) is a genetically


determined metabolic disorder that manifests clinically as
dysfunctions of the central nervous system (CNS), adrenal
glands, and testicles. These dysfunctions are related to
excessive accumulation of very long chain fatty acid (VLCFA)
in tissues and plasma, which is caused by the failure of
oxidative degradation of VLCFA that normally takes place in
peroxisomes.There is widespread demyelination of white
matter ( particularly bilateral parieto-occipital region ) with
inflammatory reaction and atrophy of adrenal cortex. .

Two year old child with neuronal


regression
Patient Data:
Age: 2
Gender: Female

Diffuse confluent
periventricular and deep
white matter increased T2
signal intensities with
sparing of subcortical U
fibers, predominantly in the
bilateral parietal region.
Linear hypointense signals
also noted in the white
matter giving
tigroid appearance.

Metachromatic leucodystrophy

5 year old boy

Macrocephaly & 'J' shaped sella

ands Proximal pointing metacarpals &


angulated radius and ulna

Inferior end plate beaking & oar shaped ribs

Hypolastic inferior ilium Hypolastic


inferior ilium and and coxa valga.

Image set description: The Skull


shows macrocephaly and J shaped
sella, the hand radiograph shows
proximal pointing metacarpals, the
DL spine radiograph shows
hypoplastic dorsolumbar vertebrae
with anterior beaking of the inferior
end plates and the pelvis radiograph
shows hypoplasia of the base of the
ilia with enlargement of the
acetabulum & coxa valga.

mucoplolyscaridosis

Mucopolysaccridosis Tapering of the


distal phalanges and widening of the
distal ends and tapering of the
proximal ends of metacarpals.

Mucopolysaccridosis Tapering of the


distal phalanges and widening of the
distal ends and tapering of the
proximal ends of metacarpals.

Mucopolysaccridosis There is
straightening of the dorsal lordosis.
The inferior-most thoracic and
superior-most lumbar vertebral
bodies show an abnormal shape with
anterior notches on either the
superior or mid-thirds, as well as a
degree of inferior beaking. The
interpedicular distance is preserved.

Mucopolysaccharidosis with thoracolu


mbar kyphosis.

Patient with coarse facial features,


cardiac murmure, gibbus and dental
decay.
Patient Data:
Age: 3
Gender: Male
Race: Middle eastern

Bullet-shaped metacarpal bones and


phalanges.
Slanting/ convergent distal radius and
ulna. Osteopenic appearance of the
wrist and hand bones with diffusely
coarse trabecular bone.

Abnormal vertebral bodies,


particularly at L2 where there is
anterior inferior beaking and focal
kyphosis.

Grossly abnormal skeletal survey.

Wide iliac wings, narrow iliac body


and hypoplastic acetabula.

Short, wide tubular bones and


pointed metacarpals with small
carpals

5 month old child with a history


of "spitting up".

Frontal image from an UGI shows


the patulous gastroesophageal
junction and the oblique angle of
His.

Gastroesophageal reflux in an infant.

9 month old child with vomiting.

Frontal image from an UGI barium


entering the distal esophagus in
a retrograde direction

Gastroesophageal reflux in an infant.

Frontal image from an UGI barium


entering the distal esophagus in
a retrograde direction and the
patulous GE junction.

Gastroesophageal reflux in an infant.

Frontal image from an UGI barium


entering the proximal esophagus
in a retrograde direction.

Gastroesophageal reflux in an infant.

Frontal image from an UGI barium


entering the proximal esophagus
in a retrograde direction.

Gastroesophageal reflux in an infant.

12 year old girl, with no symptoms.

Frontal and lateral chest


radiographs show a paraspinous
mass.

Nissen wrap.

18 year old girl with history of reflux.

Frontal image from an UGI


performed through gastrostomy
tube a normal Nissen defect in
the gastric fundus (fundal cuff).

Normal Nissen defect.

Frontal image from an


esophagram performed through
gastrostomy shows the
gastroesophageal junction
contained within the wrap.

Normal Nissen defect.

6 year old patient with Nissen


fundoplication for reflux.

Frontal image from an UGI shows


a paraesophageal hernia with the
gastroesophageal junction still
below the diaphragm.

Nissen fundoplication with


paraesophageal hernia.

Frontal image from an


esophagram shows the course of
the esophagus past the herniated
cuff.

Nissen fundoplication with


paraesophageal hernia.

12 year old boy with dysphagia.

Frontal image from an UGI shows


the hourglass appearance of
stomach, cinched at the
diaphragm hiatus.

Hiatal hernia.

18 year old girl with dysphagia.

Frontal image from an UGI the


hourglass appearance of
stomach, cinched at the
diaphragm hiatus and the
esophagus opacified by a
swallow, entering the top of the
herniated fundus.

Hiatal hernia.

5 month old child with vomiting


following Nissen fundoplication.

Frontal image from an UGI shows


a distended esophagus with
failure of barium to pass beyond
the wrap. Barium delivered by
tube in the esophagus fails to
pass into the stomach filled with
contrast by g-tube.

Esophageal obstruction from


tight Nissen fundoplication.

5 year old boy with Nissen


fundoplication for reflux.

Frontal image from an UGI shows


a broken-down wrap. There is
gastric filling with immediate
reflux.

Breakdown of a Nissen wrap.

5 year old boy with Nissen


fundoplication for reflux.

Frontal image from a swallowing


study in the same child shows a
patulous gastroesophageal
junction and impression from the
wrap.

Breakdown of a Nissen wrap.

4 month old infant with vomiting.

Frontal view from a Tc-99m-DTPA


nuclear medicine reflux study
shows activity in the distal
esophagus.

Gastroesophageal reflux.

4 month old child with vomiting.

Sagittal ultrasound image shows


a normal closed
gastroesophageal junction.

Normal.

4 month old child with vomiting.

Sagittal ultrasound image shows


an open gastroesophageal
junction containing air.

Gastroesophageal reflux.

Gastroesophageal reflux.

Sagittal ultrasound image shows


an open gastroesophageal
junction containing gas and
liquid.

Gastroesophageal reflux.

Frontal radiograph shows a steep


acetabular roof bilaterally.

Bilateral DDH.

Coronal US shows a rounded


superolateral acetabulumand the
epiphysis is displaced out of the
acetabulum toward the
transducer.

Developmental dysplasia of the hip.

Coronal US image demonstrates


the alpha angle which is obtained
by the intersection of lines drawn
in tangent to the iliac crest and
the superior acetabulum.
(femoral epiphysis).

Normal hip.

Axial US of the hip shows femur,


epiphysis, ischium, pubis.

Normal hip.

Sagittal US of the hip shows a


rounded superolateral acetabular
margin and less than 50%
coverage. (line extending from
iliac crest does not bisect the
head)

DDH.

Frontal radiograph in left DDH


demonstrating Perkin's line,
Hilgenreiner's line, and
acetabular line. The proximal
epiphysis is displaced outward
(from the normal lower inner
quadrant). Shenton's arc.

Left DDH with chronic


subluxation/dislocation.

Frontal radiograph showing


bilateral chronic dislocation.
Pseudoarticulation with iliac
bones.

Chronic bilateral hip dislocation from DDH.

Frog leg lateral radiograph of the


hips with abnormal superior
position and pseudoarticulation
with the right iliac crest.

Right DDH with dislocation.

Frontal radiograph in a child with


abnormal left hip treated with
closed reduction and application
of spica cast.

Left DDH.

Axial C-CT of the hips after rereduction shows a normal right


hip and normal alignment of the
left femoral epiphysis at the
acetabulum.

Left DDH with second


intraoperative reduction and
placement of a spica cast. Normal
alignment has been restored.

Hip arthrogram shows enlarged


pulvinar, ligamentum teres
creating a filling defect. There is
a widened medial pocket of
contrast and tight limbus.

Advanced DDH.

Frontal radiograph during


bilateral hip arthrograms shows
normal appearance on the right.
Left: steep acetabular roof and
pooling of contrast medially
resulting in widening of the joint
space.

Left DDH.

Frontal radiograph of the pelvis


shows avascular necrosis.

Right DDH with secondary


avascular necrosis.

Frontal radiograph of the pelvis


shows persistent lack of
ossification of the femoral
epiphysis .

Left DDH with secondary AVN.

Frontal radiograph status post


femoral varus osteotomy.

Right DDH post femoral varus osteotomy.

Frontal radiograph shows the


right"neoacetabulum."

Status post right acetabular


osteotomy for DDH.

Frontal radiograph of the pelvis


shows left metallic hardware
through an iliac osteotomy site.

Status post left acetabular


osteotomy for DDH.

Frontal radiograph of the hips


post left femoral varus
osteotomy.

Left DDH after femoral varus osteotomy.

Child with shortness of breath and dysphagia.

Frontal chest radiograph shows a


right-sided posterior mediastinal
mass. Reproduced with
permission from Elsevier {24}.

Spherical esophageal duplication cyst.

Child with dysphagia.

Oblique view from an upper GI


contrast study shows a large,
intramural, extraluminal mass in
the esophagus, which is
compressing the lumen.

Spherical esophageal duplication cyst.

6-month-old infant with a history


of recurrent pneumonia.

Anterior view from an upper GI


contrast study shows a tubular
mass filled with contrast.
Reproduced with permission from
Elsevier {24}.

Esophageal duplication cyst.

Infant with intractable vomiting.

Ultrasound study shows a cystic


mass located at the gastric
antrum. The lesion demonstrates
classic "gut signature": the inner
mucosal layer is echogenic and
the outer muscle layer
hypoechoic. Note the marked
"through-transmission"
posteriorly.

Enteric duplication cyst.

Neonate with respiratory distress.

Frontal chest radiograph shows a


soft tissue density mass filling
the right hemithorax, causing
contralateral shift of the heart
and mediastinal structures.
Multiple vertebral segmentation
anomalies are seen at the
cervicothoracic junction.

Thoracoabdominal esophageal
duplication cyst.

Frontal view from an upper GI


contrast study shows persistent
leak of contrast, which outlines
the fistulous tract between the
mediastinum and the jejunum.
There was no intraspinal
compone

Thoracoabdominal complex
esophageal duplication cyst.

Female infant who presented with r


espiratory distress at birth.

Frontal chest radiograph shows


Multiple vertebral segmentation
anomalies in the upper thoracic
spine and a large soft tissue
mass occupying the right
hemithorax.Image reproduced
with permission from American
Medical Association {25}.

Neurenteric cyst.

Well child.

Frontal chest radiograph shows


an incidental diagnosis of leftsided, mediastinal mass.

Bronchogenic cyst.

Asymptomatic child.

Lateral chest radiograph shows a


large mass in the middle
mediastinum.

Bronchogenic cyst.

Adolescent patient, asymptomatic.

Cropped view from a frontal


chest radiograph shows a welldefined, triangular-shaped, soft
tissue mass lying in the right
cardiophrenic angle.

Intralobar pulmonary sequestration.

3-month-old infant who presented


with recurrent apneic episodes.

Frontal view from an upper GI


contrast study shows reflux of
barium into an aberrant
bronchus, which communicates
with a left lower lobe mass.

Pulmonary sequestration.

Infant with abnormal prenatal ultrasound.

Coronal C-T1W MR image of the


chest shows a soft tissue mass
abutting the left hemidiaphragm.

Extralobar pulmonary sequestration.

Asymptomatic infant.

Frontal chest radiograph coned to


the right hemithorax shows a soft
tissue mass in the right lower
lobe. Image reproduced with
permission from Elsevier {24}.

Pulmonary sequestration.

Conventional aortogram in the


same patient shows a large
vessel arising from the aorta and
supplying the sequestrated
segment. Image reproduced with
permission from Elsevier {24}.

Pulmonary sequestration.

Anda mungkin juga menyukai