Toddler with limp who won’t bear weight on right leg

Radiograph and MRI of diskitis / osteomyelitis
Lateral radiograph of the lumbar spine shows loss of height of the L3-L4 intervertebral disc space. Sagittal T2 MRI of the lumbar spine shows (right top) loss of normal bright signal of the L3-L4 intervertebral disc and an epidural mass just posterior to the L4 vertebral body. Axial T1 MRI with contrast at the L4 level shows the epidural mass to be right sided and to also involve the right psoas muscle.

The diagnosis was osteomyelitis / diskitis.

Teenager with abnormal pleural-based nodules on CXR who had sustained blunt abdominal trauma in the remote past

CXR and CT and Tc-99m sulfur colloid scan of diaphragmatic rupture
CXR AP shows a left-sided large pleural nodule just beneath the clavicle. Axial CT with contrast of the chest shows multiple pleural nodules throughout the left hemithorax and absence of the spleen. Tc-99m sulfur-colloid scan shows normal radiotracer uptake in the liver with no uptake in the region of the spleen (lower left), and nodular uptake throughout the left hemithorax (lower middle) and abdomen (lower right).

The diagnosis was diaphragmatic rupture and post-traumatic splenosis.

Teenager in a motor vehicle accident with chest pain

CXR and CT and angiogram of thoracic aortic injury
CXR AP shows widened mediastinum. Axial CT with contrast of the chest shows dilated caliber of the thoracic aorta at the level of the diaphragm with surrounding mediastinal fluid (above) and normal caliber of the abdominal aorta with evidence of retrocrual hemorrhage tracking into the abdomen (below). Angiogram shows a pseudoaneurysm of the aorta at the level of the diaphragm.

The diagnosis was thoracic aortic injury.

Teenager in a motor vehicle accident with chest pain

CXR and CT of pneumothorax and pulmonary contusion and rib fracture
CXR AP shows a widened mediastinum and a small right-sided pneumothorax. Axial CT with contrast of the chest with lung (above) and bone (below) windows shows air in the pleural space anterior to the right lung and fluid in the pleural space posterior to the right lung as well as airspace disease in the right lower lobe and a cortical disruption through one of the right ribs posteriorly.

The diagnosis was a right hydropneumothorax, right pulmonary contusion, and right posterior rib fracture. Angiogram was negative for aortic injury.

Teenager playing football struck in chest with chest pain

CT of sternoclavicular joint dislocation
CXR AP shows a widened superior mediastinum. Axial CT with contrast of the chest shows a mediastinal hematoma and a right sternoclavicular joint disruption that was displaced posteriorly. Angiogram was negative for aortic injury. Venogram was negative for large vessel venous injury.

The diagnosis was sternoclavicular joint dislocation with the mediastinal hemorrhage thought to be due to small vessel venous injury.