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.

School ager with ankle pain after a trampoline injury

Radiograph of non-displaced Salter Harris fracture Type I of distal fibula — AP (left) and oblique (right) radiographs of the ankle show a large amount of soft tissue swelling with its apex over the fibular physis. There is a transverse lucent line through the epiphysis of the fibula.

The diagnosis was a non-displaced Salter-Harris fracture Type I of the distal fibula along with a fracture of the epiphysis of the fibula.

Teenager after a motor vehicle accident

Radiograph of a pelvis apophyseal avulsion fracture of the right anterior superior iliac spine and a pelvis fracture of the right iliac crest — AP radiograph of the pelvis shows an apophyseal avulsion fracture of the right anterior superior iliac spine and a laterally displaced fracture of the right iliac crest.

The diagnosis was a pelvis apophyseal avulsion fracture of the right anterior superior iliac spine and a pelvis fracture of the right iliac crest.

Preschooler with unusual appearing feet

Radiograph of amniotic band syndrome of the feet — AP radiograph of the feet shows in the left foot there is amputation of most of the phalanges while in the right foot there is amputation of most of the first distal phalanx and the second middle and distal phalanges.

The diagnosis was amniotic band syndrome causing amputation of the phalanges of the feet.

Teenager with a painful, red, axillary mass.

US of subcutaneous abscess — Transverse US of the axilla centered on the palpable mass shows an oval hypoechoic lesion in the subcutaneous tissue.

The diagnosis was subcutaneous abscess.

School ager who has arm pain after fall on arm

Radiograph of greenstick fracture of radius — AP (left) and lateral (right) radiographs of the forearm show a faint jagged lucency affecting one cortical surface at the diaphysis of the radius with mild angulation of the fracture fragments.

The diagnosis was greenstick fracture of the radius.

Infant exposed to a sexually transmitted disease in utero

Radiograph of syphilis osteomyelitis — AP radiograph of the lower extremities shows diffuse periosteal reaction and cortical thickening and bowing of the bilateral femora and tibae and fibulae.

The diagnosis was chronic osteomyelitis due to syphilis.

Teenager who hit the side of his foot on a door and now has pain in the proximal fifth metatarsal

Radiograph of fifth metatarsal fracture — AP (left) and oblique (right) radiographs of the foot show a transverse linear lucency through the base of the fifth metatarsal.

The diagnosis was fracture of the fifth metatarsal.

Newborn with respiratory distress

CXR of short rib polydactaly syndrome — CXR AP (left) and lateral (center) show extremely short ribs resulting in a very small thorax and thus low lung volumes. AP radiograph of the upper extremity (right) shows a short humerus and an extra digit attached to the fifth digit.

The diagnosis was short rib polydactyly syndrome with post axial polydactyly.