Teenager with shoulder pain

Radiograph of chondroblastoma of humerus — AP radiograph of the right shoulder shows a lesion in the greater tuberosity of the humerus that is lytic in appearance with some internal calcification with a thin sclerotic rim and a narrow zone of transition and no periosteal reaction.

The diagnosis was chondroblastoma.

Preschooler with a limp

Radiograph of fibrous cortical defect of the tibia — AP radiograph of the ankle shows a metadiaphyseal lesion that is lytic and within the cortex with a narrow zone of transition and a sclerotic rim and no periosteal reaction.

The diagnosis was fibrous cortical defect.

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Preschooler with a midline neck mass causing discomfort

Clinical image of thyroglossal duct cyst — AP (above) and lateral (below) clinical images show a large mass in the midline of the neck.

The diagnosis was thyroglossal duct cyst.

Pediatric Imaging Pearl of the Week

View the illustrated DDX of malignant bone tumors

Teenager with right groin mass

MRI of synovial sarcoma of groin — Axial (above right) and sagittal (below right) T2 MRI of the pelvis shows a well circumscribed soft tissue mass that is hyperintense compared to muscle and not clearly connected to any joint and that has some surrounding edema. Axial T1 MRI without contrast (above left) and axial T1 MRI with contrast (below left) show the mass to enhance homegenously.

The diagnosis was synovial sarcoma.

School ager with knee pain

Radiograph of telangiectatic osteosarcoma of femur — AP (left) and lateral (right) radiographs of the knee show a metaphyseal lesion that is lytic in appearance with an osseous matrix and a wide zone of transition and a Codman’s triangle of periosteal reaction with associated cortical destruction. On the lateral image there is a suggestion of an associated soft tissue mass posteriorly.

The diagnosis was telangiectatic osteosarcoma.

Infant with a newly diagnosed adrenal mass

Radiograph of bone metastases from neuroblastoma — AP radiographs of the humerus (above) and radius and ulna (below) show lesions involving the proximal humeral diaphysis, entire radial diaphysis and proximal ulna diaphysis all of which are lytic in appearance and having a wide zone of transition and associated faint periosteal reaction.

The diagnosis was bone metastases from neuroblastoma.

Teenager with leg pain

Radiograph of fibrosarcoma of the tibia — AP (left) and lateral (right) radiographs of the tibia and fibula show in the tibia a metaphyseal lesion that is lytic in appearance with a fibrous matrix and a wide zone of transition with cortical destruction and faint periosteal reaction.

The diagnosis was fibrosarcoma.

Teenager with right hip pain

Radiograph of chondrosarcoma of femur — AP radiograph of the pelvis shows in the right femur an epiphyseal lesion abutting the articular surface that is lytic in appearance with a faint calcification in the center of it with a chondroid matrix and a narrow zone of transition and faint periosteal reaction along the medial aspect of the femoral neck.

The diagnosis was chondrosarcoma.

Teenager with right maxillary pain

CT of chondrosarcoma of maxillary sinus — Axial CT without contrast of the maxillofacial bones shows opacification of the right maxillary sinus with thickening of the medial and posterior walls of the right maxillary sinus and destruction of the posterior aspect of the medial wall of the right maxillary sinus.

The diagnosis was chondrosarcoma.

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Toddler with a barky cough

Endoscopic image of croup — Series of endoscopic images of the airway show persistent narrowing of the subglottic trachea.

The diagnosis was croup.

Pediatric Imaging Pearl of the Week

View the illustrated DDX of osteochondroses

School ager with knee pain at the tibial tubercle

Radiograph of Osgood-Schlatter disease — Lateral radiograph of the knee shows fragmentation of the tibial tubercle and obscuration of the infrapatellar fat pad.

The diagnosis was Osgood-Schlatter disease.

School ager with elbow pain

Radiograph of Panner disease — AP (left) and lateral (right) radiographs of the elbow show a cresenteric lucency anteriorly along the capitellum along with a joint effusion causing elevation of the anterior and posterior fat pads.

The diagnosis was Panner disease.

School ager with knee pain

Radiograph of osteochondritis dissecans of the knee — AP radiograph of the knee shows fragmentation of the lateral aspect of the medial epicondyle of the knee.

The diagnosis was osteochondritis dissecans of the knee.

Preschooler who stepped on a sharp foreign body

Radiograph of Kohler disease — AP radiograph of the feet shows flattening and fragmentation of the left navicular bone and flattening of the right navicular bone.

The diagnosis was bilateral Kohler disease.

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View the illustrated DDX of osteochondroses

Teenager with a painful lump after bumping his shin 1 year ago

Gross pathological image of osteosarcoma — Gross pathological image of the tibia shows an aggressive bone lesion with cortical bone destruction and extensive periosteal reaction.

Pediatric Imaging Pearl of the Week

View the illustrated DDX of musculoskeletal infection

Infant with in-utero exposure to a sexually transmitted disease

Radiograph of osteomyelitis due to syphilis — AP radiograph of the lower extremities shows bilateral diffuse periostitis of the tibiae and some destructive changes on the medial proximal metaphysis of the left tibia (Wimberger’s sign).

The diagnosis was osteomyelitis due to syphilis.

Toddler with a limp

Radiograph of osteomyelitis with Brodie's abscess — AP radiograph of the knee at presentation (upper left) shows lucent lesions of the metaphysis and epiphysis which show some interval healing on a followup AP radiograph of the knee taken 2 months later (upper right). The patient was lost to followup and did not complete antibiotic therapy and returned to clinic 2 years later and the AP radiograph at that time (lower left) shows a lucent sinus tract extending from the epiphysis to the metaphysis that persists on the next AP radiograph of the knee obtained 1 year later (lower right).

The diagnosis was beyond neonatal to 18 months osteomyelitis with chronic osteomyelitis.

Infant with a warm, red, swollen left shoulder

Radiograph of osteomyelitis beyond neonatal to 18 months — CXR at presentation (above) is unremarkable. AP radiograph of the left shoulder obtained 5 days later (below) shows displacement and destruction of the epiphysis of the proximal humerus.

The diagnosis was beyond neonatal to 18 months osteomyelitis due to Salmonella.

Infant with a warm, red, swollen wrist

Radiograph of osteomyelitis beyond neonatal to 18 months — AP radiograph of the elbow shows a lucent destructive lesion in the distal ulna without periosteal reaction.

The diagnosis was beyond neonatal to 18 months osteomyelitis due to Streptococcus.