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.

School ager with cafe-au-lait spots

CXR and CT of plexiform neurofibroma in neurofibromatois type 1 — CXR PA shows a large soft tissue mass in the apex of the right lung which causes thinning of the right 1st-5th ribs posteriorly. CT without contrast of the chest shows multiple small nodules throughout the soft tissues of the chest wall.

The diagnosis was multiple plexiform neurofibromas in a patient with neurofibromatosis type 1.

Newborn with a posterior left chest wall mass on prenatal ultrasound

MRI of lymphatic malformation of the chest wall — Axial T1 without contrast (top), T2 (middle) and T1 with contrast (bottom) MRI of the chest shows a mass composed of multiple large fluid-filled structures separated by thin septations which faintly enhance.

The diagnosis was lymphatic malformation.

Newborn with a large left chest wall deformity

CXR and CT of mesenchymal hamartoma of chest wall — CXR AP shows a large mass arising from the left 4th-6th ribs. Axial CT without contrast of the chest with soft tissue windows (right upper and middle) show the mass to have a fluid-fluid level within it superiorly while bone windows (right lower) show the mass to be calcified.

The diagnosis was mesenchymal hamartoma of the chest wall.

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.

Teenager with right posterior chest wall pain and swelling for 2 years

CT of Ewing sarcoma of the rib — Axial CT with contrast of the chest shows a large heterogenous non-enhancing soft tissue mass centered around the posterior aspect of the right 11th rib. 3D CT reconstruction better demonstrates the lesion’s origin from the right 11th rib.

The diagnosis was Ewing sarcoma.

Young adult status post radiation therapy for sarcoma with an incidental finding on CXR

CXR and CT of osteochondroma of the rib — CXR PA shows a calcific density in the head of the left third rib. Contiguous images from an axial CT without contrast of the chest shows a bony outgrowth at the proximal aspect of the left third rib posteriorly.

The diagnosis was osteochondroma of the left third rib.

School ager with cystic fibrosis and a right chest wall mass

CXR of osteomyelitis of the rib — CXR PA and magnified view of the ribs (below) shows dense opacity in the right upper lobe and marked periosteal reaction of the right 4th rib posteriorly.

The diagnosis was botryomycosis (recurrent staphylococcus infection) resulting in osteomyelitis of the rib in a patient with cystic fibrosis.

School ager with a protuberant left chest wall

CXR and CT of pectus excavatum — CXR PA and lateral and axial CT without contrast of the chest shows marked depression of the sternum posteriorly leading to deformation of the chest wall.

The diagnosis was pectus excavatum.

Teen with a palpable anterior left chest wall mass

CXR and CT of rib fusion — CXR shows a contour irregularity of the left second rib anteriorly. 3D CT shows a pseudoarthrosis between the left first and second ribs.

The diagnosis was rib fusion / pseudoarthrosis of the left first and second ribs.

Teenager with left chest wall mass

CXR and CT of rhabdomyosarcoma of the chest wall — CXR PA and lateral (above) shows an ill defined left-sided pleural-based process. Axial CT without contrast of the chest (below) shows a mass arising from the muscles of the left chest wall which invades up into the pleural space and down into the abdomen, sparing the ribs.

The diagnosis was rhabdomyosarcoma.

Newborn with a large soft tissue mass on their back

US and CT of infantile fibrosarcoma — Sagittal US of the mass (above) revealed increased vascularity peripherally and central ulceration. Axial and sagittal CT with contrast of the chest (below) shows a mass arising near the right scapula of heterogenous density with variable enhancement.

The diagnosis was infantile fibrosarcoma.

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 coli.

Infant with severe eczema and an enlarging left chest wall mass over the last week and elevated white count

CT and MRI of osteomyelitis of the rib — Axial CT without contrast of the chest (above) shows bilateral axillary adenopathy and soft tissue swelling over the left lateral chest wall and associated rib destruction. Coronal T2 MRI of the chest (below left) shows a high signal intensity fluid collection between the skin and the ribs with surrounding edema. Axial T1 MRI with contrast of the chest (below right) shows extensive enhancement of the left ribs and surrounding muscle.

The diagnosis was cellulitis and a subcutaneous abscess resulting in osteomyelitis of the rib via direct extension. The abscess was drained operatively and grew staphlococcus.

Preschooler with a subxiphoid chest wall mass

CT of lipoma of the chest wall and thigh — Axial CT without contrast shows a symmetrical appearing chest wall (top), a fat density center-right sided chest wall mass (middle) and a fat density anterior left thigh mass (bottom).

The diagnosis was lipoma of the chest wall and left thigh.

Infant who was on arterial-venous ECMO post cardiac arrest and has just been taken off of ECMO and who has palpable masses in the right neck and left chest wall

CT of intramuscular hematoma in patient on extracorporeal membrane oxygenation (ECMO) — Axial CT with contrast of the chest shows hematomas in the right sternocleidomastoid muscle (above) near the ECMO catheter insertion site and left pectoralis major muscle.

The diagnosis was intramuscular hematoma as a complication of ECMO.

Preschooler with left hip pain

Ultrasound of transient synovitis of the hip — Sagittal US of the hips shows a large anechoic fluid collection in the anterior recess of the left femur, which is not present in the right hip. This left hip effusion, when tapped under ultrasound guidance, returned clear fluid.

The diagnosis was transient synovitis of the hip.

Teenager with chronic right hip pain and acute left hip pain

Radiograph of Legg-Calve-Perthes disease and slipped capital femoral epiphysis — AP (above) and frogleg (below) radiographs of the pelvis shows the right femoral head to be flat and enlarged with femoral neck shortening. The left femoral epiphysis is slipped posteromedially.

The diagnosis was chronic right Legg-Calve-Perthes disease and left slipped capital femoral epiphysis.

Teenager with left hip pain

Radiograph and CT of slipped capital femoral epiphysis — AP radiograph of the pelvis shows a fracture through the left physeal growth plate causing the femoral epiphysis to sublux off of the femoral metaphysis. This is more clearly seen on the coronal 2D reconstruction CT of the pelvis.

The diagnosis was slipped capital femoral epiphysis.

Preschooler with left hip pain

Radiograph and ultrasound of septic arthritis of the hip — AP radiograph of the pelvis was unremarkable. Sagittal US of the hips shows a large anechoic fluid collection in the anterior recess of the left femur, which is not present in the right hip. This left hip effusion, when tapped under ultrasound guidance, returned green pus.

The diagnosis was septic arthritis of hip.

Teenager with left hip pain

Radiograph of parosteal osteosarcoma of the femur — AP and lateral radiographs of the left hip shows a poorly circumscribed, sclerotic, expansile lesion that appears to be attached to the cortex.

The diagnosis was parosteal osteosarcoma of the femur.

School ager with a left limp

Radiograph and nuclear medicine bone scan of osteomyelitis of the femur — AP radiograph of the pelvis was unremarkable. Nuclear medicine bone scan shows increased radiotracer uptake in the left femoral head and neck and proximal femur.

The diagnosis was osteomyelitis of the left femur.

School ager with right hip pain

Radiograph and CT of osteoid osteoma of the femur — AP radiograph of the pelvis shows a round lucent lesion in the right femoral neck. Coronal 2D reconstruction and axial CT without contrast of the pelvis shows the lesion to be centered in the cortex, to have a central calcification in a radiolucent nidus, and to be surrounded by reactive sclerosis. There is also a left hip effusion on the lower left CT image.

The diagnosis was osteoid osteoma of the femur.

Preschooler with bilateral hip pain

Radiograph of neuroblastoma bone metastases to the femur — AP radiograph of the femurs shows a mottled appearance to both femurs with multiple lytic lesions noted in the femurs with associated periosteal reaction, more prominent on the left than the right.

The diagnosis was metastases from neuroblastoma.

Infant with right hip pain

Radiograph of Langerhans Cell Histiocytosis of the femur — AP radiograph of the pelvis shows a well circumscribed lytic lesion in the proximal right femoral metaphysis without any associated periosteal reaction.

The diagnosis was Langerhans cell histiocytosis