Newborn with lower extremities that are asymmetric in length

Radiograph of proximal focal femoral deficiency — AP radiograph of the right femur (left) shows the right femoral head and right femoral shaft are hypoplastic in appearance. AP radiograph of the pelvis (right) shows the difference in length between the femurs.

The diagnosis was right proximal focal femoral deficiency.

School ager who fell off an all terrain vehicle

Radiograph of Salter Harris Type II fracture of the ankle — AP radiograph of the ankle shows a fracture line through the distal physis of the tibia that extends superiorly into the tibial metaphysis and the tibial fracture fragments are not in anatomic alignment and apposition. There is also a comminuted fracture of the distal fibular metaphysis and the fibular fracture fragments are not in anatomic alignment and apposition.

The diagnosis was Salter Harris fracture Type II of the tibia and a complete fracture of the fibula.

School ager with a palpable mass behind the knee

US of pediatric popliteal cyst — Transverse grayscale (above) and sagittal color doppler (below) US of the popliteal fossa show a large anechoic lesion in the popliteal fossa which is avascular and whose neck at its deepest extent was seen to extend into the joint space between the semimembranosus tendon and medial head of gastrocnemius tendon.

The diagnosis was popliteal cyst.

Newborn who experienced shoulder dystocia during delivery

CXR of humerus fracture due to shoulder dystocia — CXR AP shows a complete fracture through the diaphysis of the left humerus. The fracture fragments are not in anatomic alignment and apposition.

The diagnosis was proximal humerus fracture.

School ager with left preauricular mass

CT of pediatric pilomatricoma — Axial (above) and coronal (below) CT with contrast of the face show a well-circumscribed oval lesion near the left ear that has calcifications within it. There are no inflammatory changes associated with it.

The diagnosis was pilomatricoma.

Teenager who hurt his finger playing football

Radiograph of Salter Harris Type II fracture of phalanx — AP radiograph of the hand shows a fracture line through the physis at the base of the second proximal phalanx that extends up into the metaphysis of the phalanx.

The diagnosis was Salter Harris Type II fracture of the second proximal phalanx of the hand.

Infant being worked up for suspected child abuse

Radiograph of physiologic periosteal reaction — AP radiographs of the bilateral tibiae and fibulae show bilateral symmetrical periosteal reaction along the medial diaphyses of the tibiae.

The diagnosis was physiologic periosteal reaction.

Teenager with left hip pain

Radiograph of avulsion fracture of the left anterior superior iliac spine. — AP radiograph of the pelvis shows an avulsion fracture of the left anterior superior iliac spine.

The diagnosis was pelvis fracture and hip apophyseal avulsion of the anterior superior iliac spine.

School ager who is being followed up for a supracondylar fracture that occured 6 months ago

Radiograph of pediatric Panner disease — AP (left) and lateral (right) radiographs of the elbow show demineralization, fragmentation and sclerosis of the capitellum which also has an irregular border.

The diagnosis was Panner disease.

Teenager with a storage disease

MRI of femur in Gaucher disease — Coronal T1 MRI without contrast (left) and coronal T2 MRI (right) of the femurs shows a heterogeneous appearance to the bone marrow of the femurs due to diffuse marrow infiltration. The femurs have a mildly reduced constriction of diaphysis and flaring of metaphysis due to undertubulation, giving them the appearance of an Erhlemeyer flask.

The diagnosis was Gaucher disease.

Teenager who hurt his big toe playing football

Radiograph of Salter Harris Type III fracture of the phalanx in the foot — AP radiograph of the foot shows a lucent line in the medial aspect of the physis of the first proximal phalanx that then extends down into the epiphysis.

The diagnosis was Salter Harris Type III fracture of the phalanx in the foot.

Teenager with knee pain

Radiograph of parosteal osteosarcoma — AP and lateral radiographs of the knee show in the posterior distal femur a lobulated, exophytic mass which appears attached to the underlying cortex with minimal periosteal reaction.

The diagnosis was parosteal osteosarcoma.

Toddler hit by a car while running across the street to an ice cream truck

Radiograph of complex pediatric pelvic fracture — AP radiograph of the pelvis shows a fracture of the left inferior and left superior pubic rami, a fracture of the left iliac wing, diastasis of the symphysis pubis and diastasis of the right sacroiliac joint.

The diagnosis was a complex pelvis fracture.

Preschooler with foot pain

Radiograph and MRI of Brodie abscess — Oblique radiograph of the foot (left) shows a lesion in the base of the first metatarsal which has an oval radiolucent center with surrounding reactive sclerosis. Sagittal T2 MRI of the foot (above right) shows an oval hyperintense lesion surrounded by a very low signal intensity rim and hyperintense marrow edema throughout the first metatarsal. Sagittal T1 MRI with contrast (below right) shows rim enhancement (penumbra) around the lesion.

The diagnosis was subacute osteomyelitis with Brodie abscess.

School ager with hip pain after a fall

Radiograph of pediatric pathologic fracture through unicameral bone cyst — AP (above) and lateral (below) radiographs of the left hip show a completely displaced fracture through the femoral metaphysis. The fracture appears to go through the center of a lucent lesion in the bone.

The diagnosis was pathologic fracture through a unicameral bone cyst.

Newborn who is not moving their legs very much

Radiographs of neonatal osteomyelitis due to Pseudomonas aeruginosa — AP radiograph of the pelvis at day of life 14 (above left) is unremarkable. AP radiograph of the pelvis at day of life 28 (below left) shows boney destruction and fragmentation at the bilateral proximal femoral metaphyses. AP radiograph of the forearm at day of life 28 (right) shows boney destruction at the distal radial metaphysis.

The diagnosis was neonatal osteomyelitis due to Pseudomonas aeruginosa.

School ager with knee pain after a sledding injury

Radiograph of pediatric patellar fracture — Lateral radiograph of the knee shows an avulsion fracture of the superior pole of the patella. There is a large suprapatellar joint effusion.

The diagnosis was patella fracture.

Teenager with long standing leg pain

Whole body STIR MRI of chronic recurrent multifocal osteomyelitis — Coronal STIR MRI of the chest (above) shows increased bone marrow signal in the bilateral clavicular heads. Coronal STIR MRI of the knees (below left) and ankles (below right) shows increased bone marrow signal intensity in the bilateral distal femoral metaphyses, left distal femoral epiphysis, bilateral proximal tibial metaphyses and bilateral distal tibial metaphyses.

The diagnosis was chronic recurrent multifocal osteomyelitis.

School ager with leg pain after a fall

Radiograph of osteochondromatosis — AP (left) and lateral (right) radiographs of the leg show multiple lesions arising from the distal femoral and proximal tibial metaphyses. Some of the lesions are sessile in appearance while some are pedunculated in appearance. Each lesion has a bony stalk growing away from the metaphysis with a lucent lesion growing at the tip of each stalk with a narrow zone of transition and no associated periosteal reaction.

The diagnosis was multiple osteochondromas in a patient with osteochondromatosis.

School ager with right knee pain

Radiograph of osteochondritis dissecans of the knee — AP radiograph of the knees shows a left-sided osteochondral defect at the articular surface of the lateral aspect of the medial femoral condyle.

The diagnosis was osteochondritis dissecans of the left knee.

Teenager with knee pain

Radiograph of Osgood-Schlatter disease — AP radiograph of the knee (left) is unremarkable while lateral radiograph (right) shows infiltration and obscuration of the infrapatellar fat pad and fragmentation of the anterior tibial tubercle.

The diagnosis was Osgood-Schlatter disease.

School ager with left hip pain for 2 weeks

MRI of myositis of the hip — Axial (above left and below left) and coronal (above right) T2 with fat saturation MRI of the pelvis shows bright signal in the expanded and edematous left obturator internis and left gluteus medius muscles, which on coronal T1 MRI with contrast (below right) are shown to faintly enhance.

The diagnosis was myositis of the left hip.

School ager who has pain at the distal interphalangeal joint after jamming their finger

Radiograph of mallet finger fracture — Lateral radiograph of the finger shows a faint triangular avulsion fragment at the insertion of the common extensor tendon on the dorsal aspect of the distal phalanx at the distal interphalangeal joint.

The diagnosis was mallet finger fracture.

School ager with a left mandibular mass

CT of myofibroma — Coronal CT without contrast of the face (above left) shows a soft tissue mass adjacent to or arising from the left mandible which on coronal CT with contrast (above right) is seen to be enhancing and well circumscribed. Coronal CT with bone windows (below) better shows the mandibular disruption and destruction caused by the mass.

The diagnosis was myofibroma.

Infant with seizures and kinky appearing hair

MRA of tortuous intracranial vessels in Menkes disease — Coronal MIP MRA with contrast of the brain (above) shows tortuosity of the bilateral middle and anterior cerebral arteries and vertebrobasilar system which is also appreciated on the axial MIP MRA (below).

The diagnosis was Menkes disease.