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.

Teenager with knee pain

Radiograph of giant cell tumor of femur — AP radiograph of the knee shows growth plate fusion and a metaphyseal lesion that is lytic and expansile in appearance with a narrow zone of transition and no associated periosteal reaction.

The diagnosis was giant cell tumor.

School ager with left leg pain

Radiograph of polyostotic fibrous dysplasia — AP radiograph of the femur (above left) shows a metaphyseal lesion that is expansile, lytic in appearance, with a narrow zone of transition and no periosteal new bone that has the appearance of a shepherd’s crook. AP radiograph of the bilateral tibia and fibula (upper right) shows multiple left tibial metaphyseal and diaphyseal lesions that are lytic in appearance with a narrow zone of transition and no periosteal reaction. AP radiograph of the feet (below) shows lesions in the diaphysis of the left first metatarsal and proximal phalanx that are lytic in appearance with a narrow zone of transition and no periosteal new bone.

The diagnosis was polyostotic fibrous dysplasia.

Teenager whose right eye was becoming progressively displaced

CT of fibrous dysplasia of the orbit — Axial (above) and coronal (below) CT without contrast of the face show a lesion involving the right frontal bone and orbital roof and superior medial and lateral walls of the right orbit that has osseous matrix and ground glass appearance with a narrow zone of transition and no periosteal new bone.

The diagnosis was fibrous dysplasia.

Preschooler with a swollen middle finger

Radiograph of multiple enchondromas of the hand in Ollier disease — AP radiograph of the hand shows lesions in the third metacapal head distally and in the proximal and middle phalanges proximally that are metaphyseal in location, expansile and lytic in appearance, with a narrow zone of transition and without periosteal reaction.

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

Toddler with finger pain

Radiograph of multiple enchondromas of the hand in Maffucci syndrome — AP (left) and oblique (right) radiographs of the hand show, in the second / third / fourth phalanges, multiple metaphyseal lesions that are lytic with a narrow zone of transition and no periosteal reaction.

The diagnosis was enchondromatosis. The patient also had multiple soft tissue hemangiomas and therefore was diagnosed with Maffucci syndrome.

Schoolager with knee pain

Radiograph of cortical desmoid — AP (left) and lateral (right) radiographs of the knee show an irregularity in the contour of the posteromedial aspect of the distal femoral metaphysis.

The diagnosis was cortical desmoid.

School ager with knee pain

Radiograph of chondromyxoid fibroma of tibia — AP (left) and oblique (right) radiographs of the knee show a metaphyseal lesion that is lytic and lobulated and expansile in appearance with a narrow zone of transition and no periosteal reaction.

The diagnosis was chondromyxoid fibroma.

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.

Our DDX For This Week Is

View the illustrated DDX of benign bone tumors

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.

Our DDX For This Week Is

View the illustrated DDX of malignant bone tumors

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.