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.

Teenager with trauma to the knee 1 month ago who is now developing new symptoms of knee pain with knee movement

Radiograph of myositis ossificans — AP (left) and lateral (right) radiographs of the knee show an area of diffuse calcification in the muscles anterior and medial to the distal femur.

The diagnosis was myositis ossificans.

School ager with abnormal appearing forearms

Radiograph of Madelung deformity — AP radiograph of the left forearm (left) shows shortening and bowing of the radius and positive ulnar variance. AP radiograph of the right forearm (right) shows shortening and bowing of the radius and negative ulnar variance.

The diagnosis was bilateral Madelung deformity.

Teenager who is a baseball pitcher with right shoulder pain

Radiograph of little leaguer shoulder — AP radiograph of the right shoulder (left) shows proximal humeral epiphysiolysis and physeal widening and juxtaphyseal osteopenia and mild metaphyseal sclerosis in the lateral aspect of the right proximal humeral physis. AP radiograph of the asymptomatic left shoulder (right) shows none of these findings.

The diagnosis was little leaguer shoulder.

Teenager with a limp

Radiograph of osteofibrous dysplasia — AP (left) and lateral (right) radiographs of the lower extremities show in the tibial diaphysis multiple and too numerous to count eccentric expansile lucent lesions with bubbly and sclerotic borders which are without periosteal reaction.

The diagnosis was osteofibrous dysplasia.

School ager with a chronic cough and right shoulder pain

Radiograph of tuberculous osteomyelitis. — AP radiograph of the right shoulder shows a well circumscribed lucent lesion in the right humeral epiphysis. There is no periosteal reaction.

The diagnosis was tuberculous osteomyelitis.

Teenager with pica

AXR of lead poisoning — AXR shows multiple punctate and linear radiopaque objects in the ascending colon.

The diagnosis was lead poisoning as the patient was subsequently found to have a high serum lead level.

School ager with foot pain

Radiograph of Kohler disease — AP radiograph of the foot shows sclerosis and fragmentation of the tarsal navicular bone.

The diagnosis was Kohler disease.

Teenager who hurt their ankle playing football

Radiograph and CT of posterior malleolus fracture — Lateral radiograph of the ankle (above right) shows a bony discontinuity through the posterior aspect of the tibial plafond extending to the physis without an articular step-off which is better seen on the sagittal CT without contrast of the ankle (below).

The diagnosis was posterior malleolus fracture which is also a Salter Harris Type II fracture.

Teenager with wrist pain

Radiograph of hand in juvenile idiopathic arthritis — AP radiographs of the hands shows bilateral periarticular osteoporosis throughout the hands. There is bilateral loss of the joint spaces in the carpal bones due to cartilage destruction and erosions at the proximal interphalangeal joints.

The diagnosis was juvenile idiopathic arthritis.

Infant with irritability

CXR of infantile cortical hyperostosis — CXR AP (above) shows marked cortical thickening of all of the left ribs and the lower right ribs and the left humerus. CXR AP taken one year later (below) shows complete resolution of the cortical thickening.

The diagnosis was infantile cortical hyperostosis.

Teenager with a headache

CT of fibrous dysplasia of the sphenoid bone — Axial (left) and coronal (right) CT without contrast of the face show a lesion involving the clivus, sphenoid, and greater wing of the left sphenoid and that is causing a narrowing of the left orbital apex which has osseous matrix and ground glass appearance with a narrow zone of transition and no periosteal new bone.

The diagnosis was fibrous dysplasia.

Teenager with knee pain after twisting their knee while playing football

Radiograph of patellar dislocation — AP (above left) and lateral (above right) radiographs of the knee show the patella to be dislocated laterally and posteriorly and there is a small knee effusion. AP (below left) and lateral (below right) radiographs of the knee obtained post reduction show the patella now to be in its correct position.

The diagnosis was patellar dislocation.

Teenager with lateral hand pain after a wrestling match

Radiograph of Preiser disease — AP (left) and oblique (right) radiographs of the hand show an angulated fracture of the distal fifth metacarpal bone. The scaphoid bone is also noted to be flattened and sclerotic.

The diagnosis was Preiser disease in a patient with boxer fracture of the fifth metacarpal.

Teenager with right hip pain after an ATV accident

Radiograph of traumatic hip dislocation — AP radiograph of the pelvis shows the right femoral head to be dislocated laterally and posteriorly.

The diagnosis was right traumatic hip dislocation

Preschooler who fell and has elbow pain

The diagnosis was Monteggia fracture dislocation.