Teenager who is a runner with a limp

Radiograph of stress fracture of the femur — AP and lateral radiographs of the femur show on the AP view a transverse non-displaced healing fracture through the distal femoral diaphysis that on the lateral view has periosteal reaction and marked cortical thickening along the posterior aspect of the femur.

The diagnosis was stress fracture of the femur.

Toddler born breech who is beginning to walk who was noted to have a left limp

Radiograph of developmental dysplasia of the hip — Frogleg radiograph of the pelvis shows markedly asymmetrical ossification of the femoral epiphyses, with the left femoral epiphysis smaller in size than the right femoral epiphysis. The left acetabulum is also more shallow than the right acetabulum and the left femoral epiphysis appears slightly subluxed laterally and superiorly.

The diagnosis was developmental dysplasia of the left hip.

Teenager with back pain

Radiograph and bone scan of spondylosis — Lateral radiograph of the lumbar spine shows a lucency through the pars interarticularis of the L5 vertebral body (pars defect). Axial and coronal images from a nuclear medicine bone scan show increased radiotracer localization in the right L5 pars interarticularis.

The diagnosis was L5 spondylosis.

Teenager with chronic back pain and acute abdominal pain

Radiograph and CT of Scheuermann disease — Lateral scout radiograph and 2D sagittal reconstruction of the lumbar spine from a CT of the abdomen shows anterior wedging and Schmorl nodes deformities of the T8, T9 and T10 vertebral bodies along with disc space narrowing at those levels.

The diagnosis was Scheuermann disease.

Teenager with back pain

Radiograph and CT of osteosarcoma of spine — AP and lateral radiographs of the lumbar spine taken during a CT myelogram show loss of height of the L3 vertebral body and sclerosis of its posterior elements. Axial CT myelogram through the L3 vertebral body shows lytic lesions in the vertebral body and an expansile sclerotic appearance of the posterior elements with periosteal reaction.

The diagnosis was osteosarcoma of the spine.

Preschooler with back pain

MRI of osteomyelitis of the spine — Coronal T1 MRI without contrast of the lumbar spine (left above) shows areas of low signal intensity on the right side of the L4 and L5 vertebral bodies and a right-sided paraspinal mass all of which enhance after the administration of contrast (right above). Axial T2 MRI through the L5 vertebral body (below) shows high signal intensity in the right side of the vertebral body and in the right paraspinal mass. The disk spaces are not involved.

The diagnosis was osteomyelitis.

Teenager with back pain and scoliosis

Radiograph and CT of osteoid osteoma of the spine — AP radiograph of the thoracic spine shows an indistinct margin of the left T10 pedicle and mild scoliosis convex right. Axial CT without contrast of the T10 vertebral body with coronal and sagittal 2-D reconstructions shows a small round lucent nidus with central calcification in the left T10 pedicle surrounded by sclerosis.

The diagnosis was osteoid osteoma.

Preschooler with back pain, limited right hip motion, and a limp

Radiograph and CT of osteoblastoma of the sacrum — AP and lateral radiographs of the lumbar spine show an expansile lesion in the right side of the S3 vertebral body. Axial CT without contrast through this level shows a large round lucent nidus with central calcification in the right S3 pedicle surrounded by sclerosis.

The diagnosis was osteoblastoma of the sacrum.

Toddler with back pain

MRI of neuroblastoma invading the spinal canal — Coronal T1 MRI without contrast of the chest shows a right paraspinal mass in the region of the right adrenal gland that on axial sequences was seen to extend into the spinal canal.

The diagnosis was neuroblastoma.

School ager with back pain

Radiographs of mechanical back pain — AP, lateral and both oblique radiographs of the lumbar spine are unremarkable and show no evidence of a scotty dog deformity, thus ruling out spondylolysis.

The diagnosis was mechanical back pain.

Toddler with back pain

Radiograph of leukemia of the spine — Lateral radiograph of the thoracic spine shows diffuse osteopenia in the vertebral bodies with loss of height (vertebra plana) in all of the vertebral bodies.

The diagnosis was acute lymphoblastic leukemia involving the spine.

Preschooler with worsening back pain for 3 weeks and then refusal to walk

Radiograph and MRI of Langerhans cell histiocytosis of the spine — Lateral radiograph of the lumbar spine shows loss of height of the L1 vertebral body. Coronal and sagittal T1 MRI with contrast of the lumbar spine shows flattening (vertebra plana) and enhancement of the L1 vertebral body with a small enhancing right sided paravertebral mass.

The diagnosis was Langerhans cell histiocytosis of the spine.

Teenager with low back pain and bilateral radicular pain for 5 months

MRI of disc herniation — Sagittal and axial (at the L5 level) T1 MRI without contrast of the lumbar spine shows central and posterior displacement of the L5 intervertebral disk.

The diagnosis was disc herniation.

School ager with worsening back pain after minor fall

Radiograph and CT of Ewing sarcoma of the spine — Lateral radiograph of the spine shows collapse of the T12 vertebral body. Sagittal 2D reconstruction and axial CT without contrast of the T12 vertebral body in bone windows shows a permeative destructive process affecting it. Axial CT without contrast of the abdomen at the T12 level shows a large left-sided paraspinal soft tissue mass.

The diagnosis was Ewing sarcoma.

Toddler with limp who won’t bear weight on right leg

Radiograph and MRI of diskitis / osteomyelitis — Lateral radiograph of the lumbar spine shows loss of height of the L3-L4 intervertebral disc space. Sagittal T2 MRI of the lumbar spine shows (right top) loss of normal bright signal of the L3-L4 intervertebral disc and an epidural mass just posterior to the L4 vertebral body. Axial T1 MRI with contrast at the L4 level shows the epidural mass to be right sided and to also involve the right psoas muscle.

The diagnosis was osteomyelitis / diskitis.

School ager with lower back and left buttock pain and a limp

Radiograph and MRI of aneursymal bone cyst — Lateral radiograph of the lumbar spine shows an expansile lesion in the S2 vertebral body. Axial and sagittal T2 MRI of the lumbar spine shows the S2 expansile lesion to be well defined and to have fluid-fluid levels within it.

The diagnosis was aneurysmal bone cyst of the sacrum.

Newborn with respiratory distress

CXR of thanatophoric dysplasia — CXR AP shows narrow and short ribs, flattening of the vertebral bodies (platyspondyly) and telephone receiver deformity of the femurs.

The diagnosis was thanatophoric dysplasia.

Newborn with respiratory distress

CXR of asphyxiating thoracic dystrophy (Jeune syndrome) — CXR AP shows shortened ribs resulting in a small thorax and a normal spine.

The diagnosis was asphyxiating thoracic dystrophy.

Toddler with a neck mass with overlying skin discoloration and stridor

Radiograph and CT of soft tissue hemangioma — Lateral radiograph of the airway and axial CT without contrast of the neck shows a large heterogenous mass that displaces and compresses the trachea.

The diagnosis was soft tissue hemangioma.

Newborn with prenatal diagnosis of neck mass who was delivered via an EX utero Intrapartum Treatment (EXIT) procedure

MRI of lymphatic malformation — Transverse (above) and sagittal (below) US of the neck and coronal (above) and axial T2 MRI without contrast of the neck shows an infiltrating multicystic mass of the neck surrounding the trachea that has minimal vascularity.

The diagnosis was lymphatic malformation.

School ager with back pain

Radiograph of tuberculous osteomyelitis — AP and lateral radiographs of the spine shows a calcified paraspinal posterior mediastinal soft tissue mass to the left of the spine from T10-T12 with relative sparing of the disc spaces. A subsequent PPD was positive.

The diagnosis was tuberculous osteomyelitis / diskitis.