School ager with beta thalassemia

MRI of extramedullary hematopoesis of the spleen — Coronal T2 MRI of the abdomen (above) shows multiple round high signal intensity lesions in the spleen. Axial T1 MRI with contrast (below) shows the splenic lesions to enhance avidly and homogenously

The diagnosis was extramedullary hematopoesis in the spleen.

Toddler with elbow pain after a fall

Radiograph of lateral epicondyle elbow fracture — AP radiograph of the elbow (left) shows a fracture line through the lateral epicondyle. Lateral radiograph (right) shows elevation of the anterior and posterior fat pads due to a large elbow joint effusion.

The diagnosis was elbow fracture of the lateral epicondyle of the elbow.

Teenager post trauma

Radiograph of pediatric posterior dislocation of the elbow — AP (left) and lateral (right) radiographs of the elbow show posterior dislocation of the radius and ulna. There was a very small bone fragment superior to the coronoid process of the ulna on the lateral view which is seen between the radius and ulna on the AP view.

The diagnosis was posterior dislocation of the elbow with an associated fracture of the coronoid process of the ulna.

School ager who is having their bone age checked

Radiograph of pediatric lunotriquetral coalition — AP radiograph of the hand shows fusion of the lunate and triquetrum carpal bones.

The diagnosis was lunotriquetral carpal coalition.

School ager who fell on an outstretched hand and has elbow pain

Radiograph of pediatric elbow fracture of coronoid process of ulna — Lateral radiograph of the elbow shows elevation of the anterior and posterior fat pads of the elbow. There is a very small bone fragment just superior to the coronoid process of the ulna.

The diagnosis was elbow fracture of the coronoid process.

Teenager with right lower extremity swelling

MRI of pediatric cellulitis of the lower extremity — Two non-contiguous axial T2 MRI images of the right lower extremity show diffuse circumferential high T2 signal in the subcutaneous tissues and along the deep fascial plane. There were no abscesses seen.

The diagnosis was cellulitis of the lower extremity.

School ager who fell on an outstretched hand and now has elbow pain

Radiograph of pediatric capitellum fracture of the elbow — AP (left), oblique (middle) and lateral (right) radiographs of the elbow show a fracture line through the capitellum which is displaced anteriorly and superiorly along the humerus which is best shown on the lateral radiograph, which also shows elevation of the anterior and posterior fat pads of the elbow.

The diagnosis was elbow fracture of the capitellum.

Teenager with a soft tissue mass between the first and second digits of the hand

Radiograph and US of venous malformation of the hand — AP radiograph of the hand (above) shows a large round laminated appearing calcified lesion between the first and second digits of the hand. Transverse US of the area of calcification (below) shows two laminated appearing clots of varying age.

The diagnosis was vascular malformation of the hand in the form of a venous malformation containing a phlebolith.

Preschooler with elbow pain after being tackled

Radiograph of ossification centers of the elbow ossifying out of their normal order — AP (left) and lateral (right) radiographs of the elbow show ossification of the capitellum and internal (medial) epicondyle. The radial head is not yet ossified. No fracture or fat pad elevation is seen.

The diagnosis was no fracture of the elbow as the ossification centers of the elbow are ossifying out of their normal order as normally the radial head should ossify before the internal (medial) epicondyle according to the CRITOE mneumonic.

School ager who fell from the monkey bars and has wrist pain

Radiograph of Colles fracture — AP radiograph of the wrist (left) shows an extra-articular fracture of the distal radial metaphyseal region while the lateral (right) shows dorsal angulation and impaction of the distal fracture fragment without the involvement of the articular surface.

The diagnosis was Colles fracture.

Toddler with an unusual appearing hand

Radiograph of symbrachydactyly — AP (left) and lateral (right) radiographs of the forearm and hand shows an absence of all the bones in the hand. There are nubbins of soft tissue where the phalanges should be. The radius and ulna are bowed.

The diagnosis was symbrachydactyly.

Teenager with shoulder pain after an all terrain vehicle accident

Radiograph of clavicle fracture — AP radiographs of the clavicle show a comminuted and angulated fracture of the mid clavicle.

The diagnosis was clavicle fracture.

Teenager with joint pain

Hand radiograph of scleroderma — AP radiograph of the hand shows acroosteolysis of the second and third distal phalanges and faint soft tissue calcifications at the tips of the first, second and third distal phalanges.

The diagnosis was scleroderma.

Teenager with lightheadedness and dizziness when their head is turned to the right or the left

MRA of otational vertebral artery occlusion syndrome of the right vertebral artery — Coronal 3D MRA without contrast of the neck with the head turned to the left (above left) and right (below left) shows focal narrowing of the right vertebral artery V3 segment in both positions. Coronal 3D MRA with contrast with the neck in a neutral position (right) shows a normal appearance to the vertebral arteries.

The diagnosis was rotational vertebral artery occlusion syndrome of the right vertebral artery.

Teenager with foot pain

Foot radiograph of psoriatic arthritis — AP radiographs of the feet show interphalangeal ankylosis and joint subluxation at the middle and distal interphalangeal joints in multiple phalanges bilaterally.

The diagnosis was psoriatic arthritis.

School ager with a crooked stance

Radiograph of hemihypertrophy due to Parkes Weber syndrome — AP radiograph of the lower extremity shows a valgus deformity of the lower extremities. In addition, the soft tissues of the right thigh and calf are twice as thick as the soft tissues of the left thigh and calf.

The diagnosis was hemihypertrophy of the right lower extremity due to Parkes Weber syndrome.

School ager who fell from a horse and has pain in the middle of the right arm

Radiograph of bowing fracture of radius — AP (above) and lateral (below) radiographs of the right forearm show the radius is bowed in appearance when compared to the straightness of the ulna. No obvious fracture is seen.

The diagnosis was bowing fracture of the radius.

School ager with a myelomeningocele who is insensate in the lower extremities who had left varus derotation osteotomy surgery 2 months ago and now has new left thigh swelling

Radiograph of congenital insensitivity to pain resulting in exuberant periosteal reaction — AP (left) and lateral (right) radiographs of the left femur show a normal post operative appearance to the left hip plate and screws. There is exuberant periosteal reaction present along the femur. There is an irregular lucency in the distal femoral metaphysis.

The diagnosis was congenital insensitivity to pain resulting in exuberant periosteal reaction from an undiagnosed nondisplaced distal femur fracture.

Teenager who was hit hard during a hockey game who now has right chest pain

CT of sternoclavicular joint dislocation — 3D CT without contrast of the chest viewed anteriorly (above) shows normal alignment of the left sternoclavicular joint and malalignment of the right sternoclavicular joint. 3D CT viewed from above (below) shows the right clavicular head is displaced posteriorly to the manubrium of the sternum when compared to the left clavicular head.

The diagnosis was right posterior sternoclavicular joint dislocation.

Toddler who has been seen to be eating paint chips

Radiographs of lead poisoning — AP radiographs of the lower extremities show dense transverse lines in the proximal and distal metaphyses of the femora, tibiae and fibulae bilaterally.

The diagnosis was lead poisoning.

Teenager who is immediately post reduction of an anterior shoulder dislocation

Radiograph of Hill-Sachs deformity after anterior shoulder dislocation — Post-reduction AP (left) and Stryker (right) radiographs of the right shoulder show a defect in the posterolateral aspect of the humeral head.

The diagnosis was a Hills-Sachs deformity in a patient who had had an anterior shoulder dislocation.

Teenager with worsening back pain

MRI of tuberculous osteomyelitis of the spine — Sagittal T1 without contrast (above left) and T2 (above middle) MRI of the spine shows destruction of an intervertebral disc space and near-complete collapse of a vertebral body at the thoracolumbar junction with an associated kyphotic deformity. Sagittal T1 with contrast MRI (above right) shows a rim enhancing subligamentous fluid collection anterior to the vertebral body. Axial T1 with contrast MRI (below left) better shows the subligamentous fluid collection anterior to the vertebral body while a lower axial image (below right) shows a large rim enhancing abscess in the left posas muscle.

The diagnosis was tuberculous osteomyelitis causing discitis and a left psoas abscess.

Teenager who pivoted the wrong way while playing sports and now has right knee pain

Radiograph of patellar dislocation — AP radiograph of the knee (left) shows lateral dislocation of the patella which is confirmed on the Merchant view (right). The lateral view (center) also shows the patella is not in its normal location.

The diagnosis was patella dislocation.

Teenager with ankle pain

Radiograph and CT of non ossifying fibroma — AP radiograph of the ankle (left) shows a metaphyseal lesion that is lucent with a thin sclerotic rim, a narrow zone of transition, and no periosteal reaction. The lesion is seen on coronal CT without contrast of the ankle (right) to be cortically based.

The diagnosis was non ossifying fibroma.

Teenager with longstanding bilateral heel pain

Radiograph of Sever disease — Lateral radiographs of the left foot (above) and right foot (below) show dense calcaneal apophyses bilaterally which have been present on radiographs over the last 4 years. The calcaneal apophyses bilaterally are now nearly completely fused.

The diagnosis was bilateral Sever disease.