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.

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.

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.

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.

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.