Infant with swollen right leg

Radiograph of femur fracture in child abuse
AP radiograph of the right femur shows a lucency through the diaphysis of the right femur with no associated periosteal reaction. CXR AP shows callus formation around the right 7th and 9th ribs laterally, the right 7th-9th ribs posteriorly, the left 3rd-7th ribs laterally and the left 8th rib posteriorly.

The diagnosis was an acute displaced fracture of the right femur and chronic rib fractures of the right 7th and 9th ribs laterally, the right 7th-9th ribs posteriorly, the left 3rd-7th ribs laterally and the left 8th rib posteriorly in a child abuse patient.

Infant who has been shaken

Radiograph of classic metaphyseal lesion / bucket handle fracture / corner fracture of the tibia in child abuse
AP radiograph of the right tibia and fibula (left) shows a faint bucket handle irregularity of the distal tibial metaphysis. Lateral radiograph of the right tibia and fibula (right) shows anterior and posterior corner irregularities of the distal tibia metaphysis.

The diagnosis was a classic metaphyseal lesion (bucket handle fracture / corner fracture) of the distal right tibia in a child abuse patient.

Infant with leg pain

Radiograph of classic metaphyseal lesion / bucket handle fracture of the femur and tibia in child abuse
AP radiograph of the lower extremities shows bucket handle irregularities of the metaphyses of the bilateral distal femurs and bilateral proximal tibiae. There is also periosteal reaction of the distal left femur and bilateral tibiae.

The diagnosis was classic metaphyseal lesions (bucket handle fractures) of the bilateral distal femurs and bilateral proximal tibiae in a child abuse patient.

School ager with a rapidly enlarging soft tissue mass of the right chest and arm

CXR and CT of malignant peripheral nerve sheath tumor in neurofibromatosis type 1
CXR PA and lateral shows a right apical thoracic mass with associated rib thinning that had rapidly increased in size in a short interval. Axial CT without contrast of the chest better defined the right apical mass and demonstrated multiple serpiginous nodules in the soft tissues of the right anterior chest wall.

The diagnosis was degeneration of a plexiform neurofibroma into a malignant peripheral nerve sheath tumor in a patient with neurofibromatosis type 1.

Young adult treated for leukemia as a preschooler, now with new palpable sternal mass

CT of epithelioid sarcoma with pulmonary metastases
Axial CT without contrast of the chest with soft tissue (above) and lung (below) windows shows a heterogeneous mass contiguous with the rectus muscles and anterior to the lower sternum which appears to be eroding into the sternum along with multiple peripheral pulmonary soft tissue nodules.

The diagnosis was epithelioid sarcoma with pulmonary metastases.

Infant with torticollis and a right superior chest wall mass

CT and US of fibromatosis coli / torticollis tumor
Axial CT with contrast of the chest (above) shows asymmetry of the sternocleidomastoid muscles, right larger than left. Transverse US of the chest (middle) at the same level of the CT better shows the enlarged right sternocleidomastoid muscle. Sagittal US of the sternocleidomastoid muscles (bottom) shows the normal smooth contour of the left sternocleidomastoid muscle and the spindle shaped appearance of the right sternocleidomastoid muscle.

The diagnosis was fibromatosis colli.