Teenager with knee pain

Radiograph of parosteal osteosarcoma — AP and lateral radiographs of the knee show in the posterior distal femur a lobulated, exophytic mass which appears attached to the underlying cortex with minimal periosteal reaction.

The diagnosis was parosteal osteosarcoma.

Toddler hit by a car while running across the street to an ice cream truck

Radiograph of complex pediatric pelvic fracture — AP radiograph of the pelvis shows a fracture of the left inferior and left superior pubic rami, a fracture of the left iliac wing, diastasis of the symphysis pubis and diastasis of the right sacroiliac joint.

The diagnosis was a complex pelvis fracture.

Preschooler with foot pain

Radiograph and MRI of Brodie abscess — Oblique radiograph of the foot (left) shows a lesion in the base of the first metatarsal which has an oval radiolucent center with surrounding reactive sclerosis. Sagittal T2 MRI of the foot (above right) shows an oval hyperintense lesion surrounded by a very low signal intensity rim and hyperintense marrow edema throughout the first metatarsal. Sagittal T1 MRI with contrast (below right) shows rim enhancement (penumbra) around the lesion.

The diagnosis was subacute osteomyelitis with Brodie abscess.

School ager with hip pain after a fall

Radiograph of pediatric pathologic fracture through unicameral bone cyst — AP (above) and lateral (below) radiographs of the left hip show a completely displaced fracture through the femoral metaphysis. The fracture appears to go through the center of a lucent lesion in the bone.

The diagnosis was pathologic fracture through a unicameral bone cyst.

Newborn who is not moving their legs very much

Radiographs of neonatal osteomyelitis due to Pseudomonas aeruginosa — AP radiograph of the pelvis at day of life 14 (above left) is unremarkable. AP radiograph of the pelvis at day of life 28 (below left) shows boney destruction and fragmentation at the bilateral proximal femoral metaphyses. AP radiograph of the forearm at day of life 28 (right) shows boney destruction at the distal radial metaphysis.

The diagnosis was neonatal osteomyelitis due to Pseudomonas aeruginosa.

School ager with knee pain after a sledding injury

Radiograph of pediatric patellar fracture — Lateral radiograph of the knee shows an avulsion fracture of the superior pole of the patella. There is a large suprapatellar joint effusion.

The diagnosis was patella fracture.

Teenager with long standing leg pain

Whole body STIR MRI of chronic recurrent multifocal osteomyelitis — Coronal STIR MRI of the chest (above) shows increased bone marrow signal in the bilateral clavicular heads. Coronal STIR MRI of the knees (below left) and ankles (below right) shows increased bone marrow signal intensity in the bilateral distal femoral metaphyses, left distal femoral epiphysis, bilateral proximal tibial metaphyses and bilateral distal tibial metaphyses.

The diagnosis was chronic recurrent multifocal osteomyelitis.

School ager with leg pain after a fall

Radiograph of osteochondromatosis — AP (left) and lateral (right) radiographs of the leg show multiple lesions arising from the distal femoral and proximal tibial metaphyses. Some of the lesions are sessile in appearance while some are pedunculated in appearance. Each lesion has a bony stalk growing away from the metaphysis with a lucent lesion growing at the tip of each stalk with a narrow zone of transition and no associated periosteal reaction.

The diagnosis was multiple osteochondromas in a patient with osteochondromatosis.

School ager with right knee pain

Radiograph of osteochondritis dissecans of the knee — AP radiograph of the knees shows a left-sided osteochondral defect at the articular surface of the lateral aspect of the medial femoral condyle.

The diagnosis was osteochondritis dissecans of the left knee.

Teenager with knee pain

Radiograph of Osgood-Schlatter disease — AP radiograph of the knee (left) is unremarkable while lateral radiograph (right) shows infiltration and obscuration of the infrapatellar fat pad and fragmentation of the anterior tibial tubercle.

The diagnosis was Osgood-Schlatter disease.

School ager with left hip pain for 2 weeks

MRI of myositis of the hip — Axial (above left and below left) and coronal (above right) T2 with fat saturation MRI of the pelvis shows bright signal in the expanded and edematous left obturator internis and left gluteus medius muscles, which on coronal T1 MRI with contrast (below right) are shown to faintly enhance.

The diagnosis was myositis of the left hip.

School ager who has pain at the distal interphalangeal joint after jamming their finger

Radiograph of mallet finger fracture — Lateral radiograph of the finger shows a faint triangular avulsion fragment at the insertion of the common extensor tendon on the dorsal aspect of the distal phalanx at the distal interphalangeal joint.

The diagnosis was mallet finger fracture.

School ager with a left mandibular mass

CT of myofibroma — Coronal CT without contrast of the face (above left) shows a soft tissue mass adjacent to or arising from the left mandible which on coronal CT with contrast (above right) is seen to be enhancing and well circumscribed. Coronal CT with bone windows (below) better shows the mandibular disruption and destruction caused by the mass.

The diagnosis was myofibroma.

Infant with seizures and kinky appearing hair

MRA of tortuous intracranial vessels in Menkes disease — Coronal MIP MRA with contrast of the brain (above) shows tortuosity of the bilateral middle and anterior cerebral arteries and vertebrobasilar system which is also appreciated on the axial MIP MRA (below).

The diagnosis was Menkes disease.

Preschooler with right knee swelling after a tick bite

Radiograph of lyme arthritis of the knee — Lateral radiograph of the knee shows a large suprapatellar joint effusion.

The diagnosis was lyme arthritis.

Preschooler with forearm pain after a fall

Radiograph of greenstick fracture of the radius and bowing fracture of the ulna — AP (left) and lateral (right) radiographs of the forearm show an incomplete non-displaced fracture through one cortical surface with angulation in the mid-diaphysis of the radius. The AP radiograph also shows the ulna to be bowed in appearance.

The diagnosis was greenstick fracture of the radius and a bowing fracture of the ulna.

Preschooler with a right chest wall mass

US of lipoma of chest wall — Transverse (above) and sagittal (below) US of the chest wall show a solid well circumscribed mass in the subcutaneous tissue with heterogenous echogenicity that overall is isoechoic to adjacent fat and which did not have increased vascularity.

The diagnosis was lipoma.

Teenager with an untreated lysosomal storage disease

MRI of Gaucher disease — Coronal T1 MRI without contrast (left) and T2 MRI (right) of the femurs shows a heterogeneous appearance to the bone marrow of the femurs due to diffuse marrow infiltration. The femurs have a mildly reduced constriction of diaphysis and flaring of metaphysis due to undertubulation, giving them the appearance of an Erhlemeyer flask.

The diagnosis was Gaucher disease.

School ager with pain at the base of the fifth metatarsal after injuring their foot

Radiograph of fracture of the apophysis of the fifth metatarsal — AP (left) and oblique (right) radiographs of the foot show fragmentation of the apophysis of the fifth metatarsal and displacement of it away from the fifth metatarsal.

The diagnosis was fracture of the apophysis of the fifth metatarsal.

School ager with left hip pain for 5 weeks

Radiograph of Legg-Calve-Perthes disease — AP (left) and frog-leg (right) radiographs of the left hip show in the left femoral head a subarticular lucency and sclerosis and an irregular contour along with loss of height of the femoral head.

The diagnosis was Legg-Calve-Perthes disease.

School ager with lateral foot pain after trauma

Radiograph of fifth metatarsal fracture — AP (left) and oblique (right) radiographs of the foot show a transverse lucent line through the base of the fifth metatarsal.

The diagnosis was fracture of the fifth metatarsal.

School ager with left hip pain

Radiograph of ischiopubic synchondrosis asymmetry — Pelvic radiograph shows asymmetric enlargement of the left ischiopubic synchondrosis.

The diagnosis was ischiopubic synchondrosis asymmetry.

Preschooler whose brother fell on her arm while playing on a trampoline

Radiograph of supracondylar elbow fracture. — Lateral radiograph of the elbow shows a transverse lucent line above the condyles of the distal humerus. There is elevation of the posterior fat pad.

The diagnosis was supracondylar elbow fracture.

School ager with end stage renal disease

Radiograph of secondary hyperparathyroidism with a brown tumor of the fifth metacarpal — AP radiograph of the hand shows a lytic lesion in the fifth metacarpal with coarsening of the trabeculae and periosteal reaction along the radial aspect of the middle phalanges.

The diagnosis was secondary hyperparathyroidism with a brown tumor of the fifth metacarpal.

School ager with elbow pain after fall on to outstretched hand

Radiograph of supracondylar elbow fracture — AP radiograph of the elbow (left) shows a transverse lucent line in the distal humerus above the condyles. Lateral radiograph of the elbow (right) shows marked elevation of the anterior and posterior fat pads.

The diagnosis was supracondylar elbow fracture.