Preschooler with short stature

Radiograph of champagne glass pelvis of achrondroplasia — AP radiograph of the pelvis shows squaring of the iliac bones, flattening of the acetabulae, and small sacroiliac notches bilaterally, leading to a champagne glass appearance to the pelvic inlet.

The diagnosis was achondroplasia.

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View the illustrated DDX of skeletal dysplasias

Newborn with a neck mass

Clinical image of lymphatic malformation — Clinical images (above) show a large bilateral neck and facial mass which was demonstrated by transillumination (below) to be cystic.

The diagnosis was lymphatic malformation.

School ager with knee pain

Radiograph of Trisomy 18 — AP radiographs of the knees show lateral patellar dislocation bilaterally along with bilateral gracile bones in the femurs, tibiae and fibulae.

The diagnosis was Trisomy 18.

School ager with chronic ankle pain

Radiograph of Trevor disease — AP and lateral radiographs of the ankle (above) and 3D CT without contrast of the ankle (below) show multiple intraarticular epiphyseal osteochondromas in the tibiotalar joint.

The diagnosis was Trevor disease.

Infant with an abnormal appearance of the left shoulder

Radiograph of Sprengel deformity — CXR AP shows elevation of the left scapula, multiple upper thoracic spine vertebral body segmentation anomalies, and fusion of the right third and fourth ribs and left second and third ribs. An ossified omovertebral bar is not present.

The diagnosis was Sprengel deformity.

Teenager with non-palpable clavicles on physical exam who has no prior history of trauma

Radiograph of pseudoarthrosis of clavicle — CXR AP (above) and bilateral AP radiographs of the clavicles (below) shows bilateral non-union of the clavicles at their midpoints. The non-joined ends of the clavicles are rounded and smooth.

The diagnosis was bilateral pseudoarthrosis of the clavicles.

Infant with a whooping cough

CXR of pertussis pneumonia — CXR AP and lateral show bilateral streaky perihilar infiltrates giving the heart contour a shaggy appearance.

The diagnosis was pertussis pneumonia.

School ager with a lump on the forearm

Radiograph and US of pilomatricoma — AP radiograph of the forearm (left) shows a round faintly calcified lesion lateral to the diaphysis of the radius. Transverse (above right) and sagittal (below right) US images of the lesion show it to be in the subcutaneous tissues and to have a heterogenous speckled appearance.

The diagnosis was pilomatricoma.

Infant with TORCH infection

Radiograph of rubella osteomyelitis — AP radiograph of the knee shows shows fraying of the femoral metaphysis which has alternating radiolucent and radiodense stripes (celery stalking).

The diagnosis was congenital rubella osteomyelitis.

Infant with TORCH infection

Radiograph of rubella osteomyelitis — AP radiograph of the knee shows shows fraying of the femoral metaphysis which has alternating radiolucent and radiodense stripes (celery stalking).

The diagnosis was congenital rubella osteomyelitis.

Infant with TORCH infection

Radiograph of rubella osteomyelitis — AP radiograph of the lower extremities shows fraying of the bilateral femoral metaphyses which have alternating radiolucent and radiodense stripes (celery stalking).

The diagnosis was congenital rubella osteomyelitis.

Toddler who fell

Radiograph of Menkes disease — AP radiograph of the forearm shows metaphyseal widening of the distal radius and ulna.

The diagnosis was Menkes disease.

Teenager with leg pain

Radiograph of Camurati-Englemann disease — AP radiographs of the hip (right), knee (center) and bilateral tibiae and fibulae show symmetrical undertubulation of the right femur and bilateral tibiae manifested as densely enlarged diametaphyses in the femur and tibiae.

The diagnosis was Camurati-Englemann disease.

Toddler who is post-op from cardiac surgery with respiratory distress

CXR and US of diaphragm paralysis — CXR AP (above) shows elevation of the left hemidiaphragm. Sagittal M-mode US of the right hemidiaphragm (lower left) shows normal sinuous motion of the right hemidiaphragm while sagittal M-mode US of the left hemidiaphragm (lower right) shows no motion of the left hemidiaphragm.

The diagnosis was paralysis of the left hemidiaphragm.

Preschooler who is being treated for Wilms tumor and is immune suppressed and is septic

US of candidial microabscesses in spleen — Transverse (left) and sagittal (right) US images of the spleen show multiple, round anechoic lesions within the spleen.

The diagnosis was candidial microabscesses in the spleen.

Infant with a pain and swelling over the left clavicle

Radiograph of infantile cortical hyperostosis of clavicle — CXR AP shows marked periosteal reaction involving the left clavicle which is thickened and hyperostotic in appearance. The right clavicle is normal.

The diagnosis was infantile cortical hyperostosis.

Toddler with bowing of the right knee

Radiograph of Blount disease — AP radiograph of the knee shows a sharp angulation at the medial tibial epiphysis. The remainder of the tibia is straight.

The diagnosis was Blount disease.

Newborn missing many digits in the hand

Radiograph of hand in amniotic band syndrome — AP radiograph of the hand shows the presence of the first proximal phalanx. All the other phalanges are absent.

The diagnosis was amniotic band syndrome causing amputation of the digits.

Infant with a small sinus located at the right sternocleidomastoid muscle that had expressed some secretions

Clinical image of second branchial cleft sinus — Clinical images show a punctate cyst at the anterior border of the right sternocleidomastoid muscle (above) that with some massaging is seen to emit fluid (below).

The diagnosis was a second branchial cleft sinus.

Pediatric Imaging Pearl of the Week

View the illustrated DDX of benign bone tumors

Teenager who tripped and fell and has hip pain

Radiograph and CT and MRI of unicameral bone cyst of the femur — AP radiograph of the hip (upper left) shows a metaphyseal lesion that is expansile and lytic in appearance with a narrow zone of transition and no periosteal reaction. There is a transversely oriented linear density within it representing a fallen fragment sign. Coronal CT without contrast of the hip (upper right) better shows the cystic nature of the lesion and the fallen fragment. Coronal (left lower) T2 MRI without contrast of the hip shows the cystic nature of the lesion and axial T2 MRI (right lower) shows fluid / fluid levels within the lesion due to hemorrhage.

The diagnosis was a pathologic fracture through a unicameral bone cyst.

School ager with wrist pain after a fall on an outstretched hand

Radiograph of unicameral bone cyst of the ulna — AP (left) and lateral (right) radiographs of the forearm show a diaphyseal lesion that is expansile and lytic in appearance with a narrow zone of transition and no periosteal reaction.

The diagnosis was a unicameral bone cyst.

School ager with bumps on the bilateral calves

Radiograph of multiple osteochondromas of the knee — AP radiograph of the knees shows bilateral lesions arising from the medial aspect of each tibial metaphysis, with a bony stalk growing away from the metaphysis with a lytic lesion growing at the tip of each stalk with a narrow zone of transition and no associated periosteal reaction.

The diagnosis was bilateral tibial osteochondromas.

Teenager with knee pain

Radiograph of multiple enchondromas of knee in Ollier disease — AP radiograph of the knee shows metaphyseal lesions in the femur and tibia and fibula that are expansile and lytic in appearance with some striations within them with a narrow zone of transition and no periosteal reaction.

The diagnosis was enchondromatosis without any associated soft tissue lesions and therefore diagnosed as Ollier disease.