Purpose or Case Report: Ultrasound (US) is commonly the first-line imaging modality in pediatric body imaging due to its safety, portability, and lack of radiation. However, US is dependent on the variable skills of sonographers amplified by increased remote interpretation. US images can be misinterpreted without a clear understanding of anatomy and critical features for a diagnosis.

This educational exhibit aims to raise awareness of misdiagnosed entities in pediatric US and provide practical strategies to avoid common pitfalls. Each case will be presented with representative images and clinical context, followed by a discussion of how the initial misdiagnosis was identified and corrected.

We will present several illustrative cases, including (not limited to):
1. Mistaking the gastroesophageal junction for the pylorus due to incorrect scanning position. Proper landmarks and techniques will be reviewed to avoid this pitfall.
2. Ruptured appendicitis with inflammatory mass wrongly diagnosed as ileocolic intussusception. Review of classic features of ileocolic intussusception and possible differentials to avoid this pitfall.
3. Painful groin swelling in an infant female interpreted as a necrotic lymph node by the sonographer. Further evaluation revealed a canal of Nuck hernia with herniated ovary and vascular pedicle. Cine clips and doppler evaluation must be reviewed. The entire structure must be traced to avoid misdiagnosis.
4. Terminal ileum was falsely identified as a blind-ending appendix in a suspected appendicitis case. Review of anatomy and ultrasound features of the appendix versus terminal ileum.
5. Thickened ileocecal valve mistaken for an ileocolic intussusception. US features of normal ileocecal valve versus ileocolic intussusception will be reviewed.

This educational exhibit reminds us of the difficulties of pediatric ultrasound and its dependence on the sonographer. We aim to equip radiologists with practical insights to avoid pitfalls in diagnosis. These examples highlight the challenges that may be encountered in US and emphasize the importance of a methodical approach, thorough technique, and recognition of diagnostic errors.
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