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.

School ager with right knee pain

The diagnosis was cortical desmoid.

Toddler who fell and will not bear weight on their lower extremity

Radiograph of toddler fracture — AP (left) and lateral (right) radiographs of the tibia and fibula show a hairline spiral lucency in the tibia.

The diagnosis was toddler fracture.

School ager with hypermobile shoulders

Radiograph of cleidocranial dysostosis — AP radiograph of the clavicles (above) shows them to be hypoplastic in appearance. AP radiograph of the pelvis (below) shows delayed ossification of the pubic symphysis.

The diagnosis was cleidocranial dysostosis.

Teenager with fourth metatarsal pain

MRI of stress fracture of the fourth metatarsal — AP radiograph of the foot (above left) shows subtle cortical thickening in the diaphysis of the fourth metatarsal. Coronal (above center) and sagittal (above right) and axial (below) T2 MRI of the foot shows bright signal in the diaphysis of the fourth metatarsal.

The diagnosis was stress fracture of the fourth metatarsal.

Fetus with a genetic disorder

Radiographs of chondrodysplasia punctata — CXR AP (left), lateral radiograph of the spine (center) and AP radiograph of the right lower extremity (right) obtained post mortem show asymmetric punctate calcific deposits in the epiphyses (stippled epiphyses) and around the periarticular soft tissues of the vertebral column, tarsal bones and pelvis. Platyspondyly is also seen throughout the spine. There is shortening of the proximal long bones.

The diagnosis was chondrodysplasia punctata.

School ager who twisted their ankle and now has ankle pain

Radiograph of Salter-Harris Type III fracture of the tibia — AP radiograph of the ankle shows a lucent line through the medial aspect of the tibial epiphysis.

The diagnosis was Salter-Harris Type III fracture of the tibia.

Teenager with knee pain

Radiograph of chondroblastoma — AP radiograph of the knee shows a lytic lesion centered in the tibial epiphysis and extending into the metaphysis that has a thin sclerotic rim and a hint of intralesional calcification. The lesion has a narrow zone of transition and has no periosteal new bone associated with it.

The diagnosis was chondroblastoma.

Teenager post trauma to the tibia and fibula

Radiograph of Blount disease — AP radiograph of the knee (left) shows the medial tibial physis is widened and the medial tibial metaphysis is depressed and beaked and is delayed in ossification. AP radiograph of the lower extremity (right) shows tibial bowing is present along with genu varum.

The diagnosis was Blount disease.

Teenager with wrist pain after trauma to the wrist weeks ago

Radiograph of scaphoid fracture — AP radiograph of the wrist shows a lucent line with some adjacent sclerosis through the waist of the scaphoid bone.

The diagnosis was a healing non-displaced scaphoid fracture.

Teenager with acute lymphocytic leukemia on steroids with knee pain

Radiograph and MRI of avascular necrosis of the knee — AP (above left) and lateral (above right) radiographs of the knee shows a serpiginous sclerotic lesion in the distal femur. Coronal T1 MRI without contrast of the knee (below left) shows the lesion in the distal femur to be defined by a focal serpentine low signal line with fatty center (reactive interface line) while coronal T2 MRI (below right) shows the lesion in the distal femur to be defined by a serpentine outer dark line and an inner bright line (double line sign).

The diagnosis was avascular necrosis of the knee.