Posts Categorized: Pediatric

What is causing sudden right-side blindness in this 10-year-old girl?

This 10-year-old female has a history of systemic lupus erythematosus and has suddenly developed right-side blindness. She is dealing with an undiagnosed clinical syndrome, as well as a complication. Identifying both the underlying syndrome and its complication will be critical to the treatment plan. Answer: She is dealing with an intracranial hemorrhage as a complication… Read more »

Which rare congenital disorder is afflicting this three-year-old?

This three-year-old female with multiple congenital hairy nevi syndrome presents with speech difficulty and right hemiparesis. Which rare congenital disorder does she have, and what more common findings is this condition known to mimic? The first image shown is an axial T1 post-contrast with ill-defined meningeal enhancement (pink arrow), while images two and three are… Read more »

What is this infant’s diagnosis after suspected Zika exposure?

This 3-month-old is suspected to have had Zika and toxoplasmosis exposure during pregnancy. Given these factors, and based on the four MRI images and one CT image (bottom) shown, what is her current diagnosis? Are there notable components of the brain that have been spared? The sequela to this Zika/toxoplasmosis exposure is diffuse cortical dysplasia… Read more »

What is this nine-year-old’s unusual gymnastics injury?

This 9-year-old presents with an elbow injury from gymnastics. What is the mechanism? What does the solitary arrow indicate? What is the accompanying soft tissue injury? What do the double arrows indicate? The findings are the result of an acute valgus insult. The capitellum (single arrow) is edematous, a sign of this mechanism. The soft… Read more »

Is there cause for concern in this 10-year-old with knee pain?

This 10-year-old presents with right knee pain and swelling. There is no known trauma. What’s the most likely diagnosis? What is indicated by the arrows in the back of the knee? Is it concerning?   The diagnosis is Sinding-Larsen-Johansson syndrome or inferior patellar “apophysitis” (yellow arrow). The green arrows indicate lymph nodes, and they are… Read more »

ADEM or MS? How to differentiate between two favored diagnoses

This 15-year-old presents with blurred vision and white-matter lesions on axial FLAIR MRI. Acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS) are the two favored diagnoses, so what questions would you ask to differentiate? You should ask: How long has this symptom been present? Is it clinically monophasic or polyphasic? Was there a recent upper… Read more »

A meniscus case with some dangerous verbiage

This 12-year-old female presents with left knee pain, and the clinician alleges meniscal tear. The initial read was noncommunicating tear, but is this the proper call? You are shown four gradient echo sagittal water-weighted images and one sagittal T1.   No, this was not the proper call! Save the whales and the menisci. It’s a… Read more »

Ten-Year-Old With Hearing Loss: What Are The Tipoffs?

10-year-old male with bilateral hearing loss and a bout of meningitis. You are shown one sagittal CT reconstruction. What is the diagnosis? What are some clinical tipoffs? Be sure to think about your answer, then scroll below to see mine. Cystic cochleovestibular anomaly. Clinical tipoffs – Congenital deafness plus recurrent bacterial meningitis. ProScan Pearl: Remember… Read more »

Known tibia diagnosis, but still questions about management

This 13-year-old presents with a tibia lesion. You know the diagnosis. What should you do to recommend management? The diagnosis is osteoid osteoma. Treat the pain with aspirin or anti-inflammatory agents. But, these lesions will burn out and should not be lasered, removed, etc. Save the whales! Save the shins of our children! Leave osteoid… Read more »

White Blob Around ACL?

What does the mass “white blob” around the ACL imply in this case? Come up with your own answer, then scroll down to see my findings. Of course lesion is bright (except on T1), smooth oval and therefore cyst (actually a ganglion pseudocyst). Some refer to this as mucoid lesion of the ACL. ProScan Pearl:… Read more »