Afebrile preschooler with a painful left limp who “walks like a monster”

Radiograph of transient synovitis of the hip — AP (above) and frog leg (below) radiographs of the pelvis show the left femoral head on both views is slightly more displaced laterally than the right femoral head, suggesting the presence of a left hip effusion.

The diagnosis was transient synovitis of the left hip.

Toddler with a left medial canthus mass

MRI of lymphatic malformation of orbit — Coronal T1 MRI without contrast (left) shows a round low signal intensity left medial canthus lesion that is high signal intensity on T2 (middle) and that does not enhance with contrast (right).

The diagnosis was lymphatic malformation of the orbit.

Teenager with sickle cell disease and respiratory distress

CXR of H-shaped vertebral bodies in sickle cell disease — CXR AP (left) shows opacity in the left lower lobe that on the lateral (middle) is located posteriorly (spine sign). The vertebral bodies (right) have an H-shaped appearance throughout the thoracic and lumbar spine.

The diagnosis was acute chest syndrome and musculoskeletal manifestations of sickle cell disease.

School ager with right thigh mass

CT and MRI of osteoid osteoma — AP radiograph of the femur (above left) shows tremendous cortical thickening of the femoral diaphysis. Axial CT without contrast of the femur (above right) shows a round lucent lesion with central calcification within the center of the tremendously thickened cortex. Axial T2 MRI (middle) through the lesion shows a tremendous amount of edema surrounding the thickened cortex of the right femur. Coronal T1 MRI without (below left) and with (below right) contrast of the femur shows the lesion to enhance.

The diagnosis was osteoid osteoma.

Teenager whose arm was hit by a baseball

Radiograph of greenstick fracture — AP and lateral radiographs of the forearm show a partial fracture with mild angulation through the distal ulna.

The diagnosis was greenstick fracture.

School ager with elbow pain after fall

Radiograph of medial epicondyle elbow fracture — AP radiograph of the elbow shows avulsion and rotation of the medial epicondyle.

The diagnosis was medial epicondyle elbow fracture.

Newborn with breech presentation

US of development dysplasia of the hip — Coronal US of the bilateral hips shows lateral subluxation of the left femoral head out of the left acetabulum with less than 50% coverage of the left femoral head and a decreased alpha angle of the left hip of 45 degrees. There is a normal alpha angle of the right hip of 69 degrees and the right femoral head is > 50% covered.

The diagnosis was left-sided developmental dysplasia of the hip.

Infant with a positive Barlow and Ortolani maneuver in the left hip at birth

US of developmental dysplasia of the hip — Coronal ultrasound images of the left hip (left) and right hip (right) were obtained after 5 weeks of therapy in a Pavlik harness with the patient located in the Pavlik harness during the exam. The coronal view is meant to simulate an anterior-posterior radiograph of the hip. The left hip is still dysplastic with there still being a shallow acetabulum and decreased alpha angle even though the left hip appears fairly well located in the left acetabulum. The left hip alpha angle measured 45 degrees (normal is usually greater than 60 degrees) but had increased since the last exam. The right hip was normal in appearance.

The diagnosis was resolving developmental dysplasia of the left hip.

School ager with a heliotrope rash, pain and proximal weakness

MRI of dermatomyositis — Axial T2 MRI through the hips (above) shows small patchy areas of increased T2 signal bilaterally and symmetrically in the gluteus muscles and in the subcutaneous tissues of the lateral and posterior thighs which show mild enhancement on axial T1 MRI with contrast (below).

The diagnosis was mild dermatomyositis.

Infant post unexplained cardiac arrest

CXR of rib fractures in child abuse — CXR AP shows acute fractures of the left 5th through 8th ribs laterally.

The diagnosis was lateral rib fractures in child abuse.

Teenager with a prominence over the ulna

Radiograph of Madelung deformity — AP radiograph of the wrist (left) shows a positive ulnar variance and a V-shaped proximal carpal row while the lateral radiograph (right) shows palmar carpal subluxation.

The diagnosis was Madelung deformity.

Teenager with headaches and balance problems

Radiograph and MRI of abnormal adolescent idiopathic scoliosis — AP radiograph of the spine (left) shows thoracic scoliosis convex left (levoscoliosis) with a compensatory lumbar scoliosis convex right, thus this is an atypical scoliosis curve for adolescent idiopathic scoliosis. Sagittal T1 MRI without contrast of the cervical spine (above right) shows the tip of the cerebellar tonsils over 10 mm beneath the foramen magnum. Sagittal and axial T2 MRI of the thoracic spine (below right) show a large syrinx in the center of the thoracic spinal cord.

The diagnosis was abnormal adolescent idiopathic scoliosis due to a Chiari I malformation causing a syrinx of the spinal cord.

Preschooler with a genetic syndrome

Radiograph of Hurler syndrome — CXR AP (left) shows widened ribs which are narrowed at the costovertebral junction (oar-shaped). Lateral radiograph of the spine (right) shows anterior beaking of the inferior aspect of the L3 vertebral body.

The diagnosis was Mucopolysaccharidoses Type I / Hurler syndrome.

School ager with knee pain for several months

MRI of subacute osteomyelitis / Brodie abscess — Sagittal T1 MRI without contrast of the knee (left) shows a small round low signal intensity lesion in the middle of the proximal tibia that is surrounded by low signal intensity peri-lesional marrow edema. Sagittal T1 MRI with contrast (center) better demonstrates the small round low signal intensity lesion and coronal T1 MRI with contrast (right) shows a faint enhancing ring (penumbra) around the lesion.

The diagnosis was subacute osteomyelitis with Brodie abscess.

Teenager with lower back pain for 8 months

Radiograph of spondylolisthesis — Lateral radiograph of the lumbar spine shows bilateral pars defects at L5 and Grade I anterolisthesis of L5 on S1.

The diagnosis was spondylolisthesis.

Teenager with muscular dystrophy

Radiograph of neuromuscular scoliosis — AP radiograph of the spine shows thoracic scoliosis convex right without a compensatory curve.

The diagnosis was neuromuscular scoliosis.

Newborn with a limb abnormality on prenatal ultrasound

Radiograph of proximal focal femoral deficiency — Radiograph of the lower extremities shows an absent right femur and a deformity of the left femur.

The diagnosis was bilateral proximal focal femoral deficiency.

Preschooler with talipes equinovarus of the left foot

Radiograph of club foot — Radiograph of the feet shows varus angulation of the left forefoot. There is a dysplastic appearing medial cuneiform bone with associated widening at the first tarsal-metatarsal joint.

The diagnosis was club foot.

Infant with a back mass

CT of fibromatosis — Axial (above), coronal (below left) and sagittal (below right) CT with contrast of the abdomen show a round, avidly enhancing soft tissue mass arising from the subcutaneous tissues to the left of midline.

The diagnosis was fibromatosis.

Teenager with bilateral knee swelling who has untreated Lyme disease

Radiograph of lyme arthritis of the knees — AP and lateral radiographs of the right knee (above) and left knee (below) shows large bilateral suprapatellar joint effusions, right greater than left.

The diagnosis was Lyme arthritis.

Preschooler with short stature

Pelvis radiograph of spondyloepiphyseal dysplasia — AP radiograph of the pelvis shows delayed ossification of the femoral heads, with multiple femoral head ossification centers present along with delayed ossification of the pubic bones.

The diagnosis was spondyloepiphyseal dysplasia.

Preschooler with short stature

Spine radiographs of spondyloepiphyseal dysplasia — AP radiograph of the lumbar spine (left) shows delayed ossification of the femoral heads and delayed ossification of the pubic bones along with progressive narrowing of the distance between the pedicles descending through the lumbar spine (interpediculate narrowing). Lateral radiograph of the lumbar spine (right) shows the vertebral bodies to have anterior wedging and a pear shape leading to some kyphosis.

The diagnosis was spondyloepiphyseal dysplasia.

Preschooler with short stature

CT and skull radiographs of pyknodysostosis — AP and lateral radiographs of the skull (above) and axial CT without contrast of the brain (below) shows diffusely sclerotic skull bones with a thickened diploic space and diastatis of the coronal and lambdoid and sagittal sutures.

The diagnosis was pyknodysostosis.

Preschooler with short stature

Lower extremity radiograph of pyknodysostosis — AP radiographs of the lower extremities shows generalized osteosclerosis of the bones without a bone in bone appearance.

The diagnosis was pyknodysostosis.

Toddler with abnormally shaped extremities

Radiograph of osteogenesis imperfecta Type I — AP radiograph of the lower extremities shows diffuse osteopenia of the bones which are also gracile and which have chronic healing fractures present.

The diagnosis was osteogenesis imperfecta Type I mild.