Newborn with a large soft tissue mass on the back

Clinical image of infantile fibrosarcoma — Clinical image shows a large mass in the upper right back with overlying skin necrosis.

The diagnosis was infantile fibrosarcoma.

Pediatric Imaging Pearl of the Week

The illustrated DDX can be found here.

Young adult with a thick skull

Radiograph of thalassemia in the skull — Lateral radiograph of the skull shows widening of the diploic space, thinning of the inner and outer tables of the skull, and an overall hair-on-end appearance with sparing of the occipital bone.

The diagnosis was thalassemia.

Teenager with respiratory distress

CXR of extramedullary hematopoesis in thalassemia — CXR AP shows diffuse osteopenia of the bones, lobulated masses projecting over the posterior portions of the ribs bilaterally, and an expanded appearance of the anterior and posterior aspects of the ribs.

The diagnosis was thalassemia with extramedullary hematopoesis.

Young adult with back pain

Radiograph of sickle cell disease of the spine — Lateral radiograph of the thoracic spine shows multiple H-shaped vertebral bodies.

The diagnosis was sickle cell disease.

Infant with stridor

Radiograph and CT of chloroma in acute myelocytic leukemia — Lateral radiograph of the airway (above) shows a large amount of retropharyngeal soft tissue swelling. Axial CT with contrast of the neck (below) shows a large round low density lesion in the left parapharyngeal space.

The diagnosis was chloroma in a patient with acute myelogenous leukemia.

Infant with abnormal lower extremity posturing

Radiograph of osteopetrosis in the femur — AP radiograph of the pelvis shows an osteosclerotic appearance to the bones with obliteration of the marrow spaces and a developing bone within bone appearance especially in the femurs.

The diagnosis was osteopetrosis.

Teenager with bilateral knee pain

Radiograph of hemophilia in the knees — AP (above) and lateral (below) radiographs of the knees show knee joint capsular distension due to dense effusions (left > right), periarticular osteopenia, joint space narrowing, subchondral cysts and epiphyseal overgrowth.

The diagnosis was hemophilia.

School ager with back pain

Radiograph of acute lymphoblastic leukemia in the spine — Lateral radiographs at presentation of the thoracic (left) and lumbar (middle) spine show diffuse osteopenia and loss of vertebral body height throughout the spine while lateral radiograph obtained a decade later of the lumbar spine (right) shows a faint bone within bone appearance of the vertebral bodies.

The diagnosis was acute lymphoblastic leukemia.

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Preschooler with stridor and drooling

Gross pathological image of epiglottitis — Gross pathological image shows a swollen epiglottis in the midline of the specimen with thickened aryepiglottic folds visible lateral to it.

The diagnosis was epiglottitis.

Pediatric Imaging Pearl of the Week

The illustrated DDX can be found here.

Teenager with an “S”-shaped spinal curvature

Radiograph of adolescent idiopathic scoliosis — AP radiograph of the spine shows a primary curvature of the thoracic spine convex to the right and a compensatory curvature of the lumbar spine convex to the left.

The diagnosis was adolescent idiopathic scoliosis.

Infant with a curvature to the spine

Radiograph and tomogram of congenital scoliosis due to congenital bar — AP radiograph of the lumbar spine (left) demonstrates a curvature of the thoracolumbar spine convex to the left caused by a fusion of the right sided pedicles of the L1 and L2 vertebral bodies which is better demonstrated on the tomographic image (right).

The diagnosis was congenital scoliosis due to a congenital bar.

School ager status post radiation therapy to the spine for a right adrenal neuroblastoma now with a curvature to the spine

CXR of post radiation scoliosis — CXR AP shows a mild curvature of the thoracolumbar spine convex to the left. Several calcifications are seen projecting over the liver.

The diagnosis was post radiation scoliosis in a patient with neuroblastoma.

Infant with respiratory distress

CXR of congenital scoliosis due to rib fusion — CXR AP shows multiple left-sided anterior and multiple right-sided posterior rib fusions and a mild curvature of the spine convex left resulting in a small thorax.

The diagnosis was congenital scoliosis secondary to rib fusion causing pulmonary hypoplasia.

School ager with back pain

Plain film and CT and bone scan of osteoid osteoma of the spine — AP radiograph of the thoracic spine (left upper) shows a mild curvature of the spine convex right and the left pedicle of the T12 vertebral body is difficult to visualize. Axial CT without contrast of the T12 vertebral body (right upper) shows a lesion with a lucent nidus surrounded by a sclerotic rim in the left pedicle of the T12 vertebral body. Pinhole (left lower) and whole body (right lower) images from a nuclear medicine bone scan show focally increased radiotracer localization in the left pedicle of the T12 vertebral body and a curvature of the spine convex right.

The diagnosis was painful scoliosis secondary to an osteoid osteoma in the left pedicle of the T12 vertebral body.

Teenager status post radiation therapy to the spine now with a curvature to the spine

CXR of post radiation scoliosis — CXR AP (left) taken as an infant shows a round left-sided soft tissue mass that was in the posterior mediastinum and found to be neuroblastoma that was subsequently treated in part with radiation therapy. CXR AP (right) taken 17 years later shows a curvature of the upper thoracic spine convex to the right.

The diagnosis was post radiation scoliosis in a patient with neuroblastoma.

School ager with a posterior mediastinal mass

CXR of congenital scoliosis and neurenteric cyst — CXR AP shows a round soft tissue density in the superior and medial aspect of the right hemithorax which was found on cross sectional imaging to be in the posterior mediastinum, along with multiple hemivertebra segmentation anomalies of the lower cervical and upper thoracic spine causing a curvature of the upper thoracic spine convex to the right.

The diagnosis was congenital scoliosis secondary to hemivertebra in a patient with a neurenteric cyst.

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School ager female with abdominal pain and an abdominal mass

Surgical image of ovarian dysgerminoma causing ovarian torsion — Surgical image (above) shows a mass arising from the left ovary. Surgical image (below) shows the left adnexal pedicle to be twisted in the center of the image. The mass and the left ovary and the fallopian tube were found to be torsed.

The diagnosis was ovarian dysgerminoma causing ovarian torsion.

Pediatric Imaging Pearl of the Week

The illustrated DDX can be found here.

Preschooler with a dietary deficiency

Radiograph of scurvy — AP and lateral radiographs of the lower extremity show thinned cortices and calcified subperiostial hemorrhage around the distal femurs, left greater than right.

The diagnosis was scurvy.

Toddler with poor weight and height gain

Radiograph of Vitamin D deficiency rickets — CXR AP (above) shows prominence of the anterior ribs near the costochondral junctions (rachitic rosary). AP and lateral radiograph of the wrist (below) shows cupping of the distal radius and ulna metaphyses.

The diagnosis was Vitamin D deficiency rickets.

Toddler with a genetic disease

Radiograph of hypophosphatemic rickets — AP radiograph of the knees (above) shows cupping of the metaphyses in the bilateral distal femurs and proximal tibias while AP radiograph of the wrists (below) shows cupping of the distal radius and ulna metaphyses bilaterally.

The diagnosis was hereditary hypophosphatemic rickets.