Preschooler with stridor and drooling

Gross pathological image of epiglottitis — Gross pathological image shows a swollen epiglottis in the midline of the specimen with thickened aryepiglottic folds visible lateral to it.

The diagnosis was epiglottitis.

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Teenager with an “S”-shaped spinal curvature

Radiograph of adolescent idiopathic scoliosis — AP radiograph of the spine shows a primary curvature of the thoracic spine convex to the right and a compensatory curvature of the lumbar spine convex to the left.

The diagnosis was adolescent idiopathic scoliosis.

Infant with a curvature to the spine

Radiograph and tomogram of congenital scoliosis due to congenital bar — AP radiograph of the lumbar spine (left) demonstrates a curvature of the thoracolumbar spine convex to the left caused by a fusion of the right sided pedicles of the L1 and L2 vertebral bodies which is better demonstrated on the tomographic image (right).

The diagnosis was congenital scoliosis due to a congenital bar vertebral body anomaly.

School ager status post radiation therapy to the spine for a right adrenal neuroblastoma now with a curvature to the spine

CXR of post radiation scoliosis — CXR AP shows a mild curvature of the thoracolumbar spine convex to the left. Several calcifications are seen projecting over the liver.

The diagnosis was post radiation scoliosis in a patient with neuroblastoma.

Infant with respiratory distress

CXR of congenital scoliosis due to rib fusion — CXR AP shows multiple left-sided anterior and multiple right-sided posterior rib fusions and a mild curvature of the spine convex left resulting in a small thorax.

The diagnosis was congenital scoliosis secondary to rib fusion causing pulmonary hypoplasia.

School ager with back pain

Plain film and CT and bone scan of osteoid osteoma of the spine — AP radiograph of the thoracic spine (left upper) shows a mild curvature of the spine convex right and the left pedicle of the T12 vertebral body is difficult to visualize. Axial CT without contrast of the T12 vertebral body (right upper) shows a lesion with a lucent nidus surrounded by a sclerotic rim in the left pedicle of the T12 vertebral body. Pinhole (left lower) and whole body (right lower) images from a nuclear medicine bone scan show focally increased radiotracer localization in the left pedicle of the T12 vertebral body and a curvature of the spine convex right.

The diagnosis was painful scoliosis secondary to an osteoid osteoma in the left pedicle of the T12 vertebral body.

Teenager status post radiation therapy to the spine now with a curvature to the spine

CXR of post radiation scoliosis — CXR AP (left) taken as an infant shows a round left-sided soft tissue mass that was in the posterior mediastinum and found to be neuroblastoma that was subsequently treated in part with radiation therapy. CXR AP (right) taken 17 years later shows a curvature of the upper thoracic spine convex to the right.

The diagnosis was post radiation scoliosis in a patient with neuroblastoma.

School ager with a posterior mediastinal mass

CXR of congenital scoliosis and neurenteric cyst — CXR AP shows a round soft tissue density in the superior and medial aspect of the right hemithorax which was found on cross sectional imaging to be in the posterior mediastinum, along with multiple hemivertebra segmentation anomalies of the lower cervical and upper thoracic spine causing a curvature of the upper thoracic spine convex to the right.

The diagnosis was congenital scoliosis secondary to hemivertebra vertebral body anomaly in a patient with a neurenteric cyst.

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School ager female with abdominal pain and an abdominal mass

Surgical image of ovarian dysgerminoma causing ovarian torsion — Surgical image (above) shows a mass arising from the left ovary. Surgical image (below) shows the left adnexal pedicle to be twisted in the center of the image. The mass and the left ovary and the fallopian tube were found to be torsed.

The diagnosis was ovarian dysgerminoma causing ovarian torsion.

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Preschooler with a dietary deficiency

Radiograph of scurvy — AP and lateral radiographs of the lower extremity show thinned cortices and calcified subperiostial hemorrhage around the distal femurs, left greater than right.

The diagnosis was scurvy.

Toddler with poor weight and height gain

Radiograph of Vitamin D deficiency rickets — CXR AP (above) shows prominence of the anterior ribs near the costochondral junctions (rachitic rosary). AP and lateral radiograph of the wrist (below) shows cupping of the distal radius and ulna metaphyses.

The diagnosis was Vitamin D deficiency rickets.

Toddler with a genetic disease

Radiograph of hypophosphatemic rickets — AP radiograph of the knees (above) shows cupping of the metaphyses in the bilateral distal femurs and proximal tibias while AP radiograph of the wrists (below) shows cupping of the distal radius and ulna metaphyses bilaterally.

The diagnosis was hereditary hypophosphatemic rickets.

Preschooler with a genetic disease

Radiograph of hypophosphatemic rickets — AP radiograph of the knees (above) shows widening of the physis medially in the bilateral distal femurs and proximal tibias while AP radiograph of the wrists (below) shows cupping of the distal ulna metaphyses bilaterally.

The diagnosis was hereditary hypophosphatemic rickets.

School ager with a genetic disease

Radiograph of hypophosphatemic rickets — AP radiograph of the lower extremities shows bowing of the bilateral femurs and tibias and widening of the physis medially in the bilateral distal femurs and proximal tibias.

The diagnosis was hereditary hypophosphatemic rickets.

School ager with renal failure

Radiograph of secondary hyperparathyroidism — AP radiograph of the knee shows widening of the distal physis of the femur and the proximal physis of the tibia and fibula and frayed metaphyses in the same areas.

The diagnosis was secondary hyperparathyroidism.

School ager with short stature

Radiograph of pseudohypoparathyroidism — AP radiograph of the hands shows shortening of the metacarpals and an extremely short right fourth metacarpal.

The diagnosis was pseudohypoparathyroidism.

Infant on Prostaglandin-E for ductus-dependent complex congenital heart disease

Radiograph of prostaglandin osteopathy — AP (left) and lateral (right) radiographs of the lower extremity shows thick, dense periosteal reaction along the femur, tibia, and fibula.

The diagnosis was prostaglandin osteopathy.

Preschooler with pica and constipation

Radiograph of lead poisoning — AXR AP (left) shows a marked amount of constipation with punctate radioopaque objects throughout the colon, most clearly seen in the magnified AP view of the rectum (center). AP radiograph of the wrist (right) shows a dense line in the metaphysis of the radius.

The diagnosis was lead poisoning.

School ager with a dietary surplus

Radiograph of hypervitaminosis A — AP radiograph of the bilateral femurs (above) shows diffuse periosteal reaction along the lateral borders of the femoral diaphyses, left greater than right. Lateral radiograph of the forearm (below) shows dense periosteal reaction along the posterior aspect of the ulna.

The diagnosis was hypervitaminosis A.

Teenager with seizures and an elevated parathyroid hormone level

CT of primary hyperparathyroidism — Bone windows from an axial CT without contrast of the brain shows salt and pepper lesions diffusely throughout the skull.

The diagnosis was primary hyperparathyroidism.

Toddler with a dietary deficiency

Radiograph of copper decificency — AP radiograph of the knee shows metaphyseal cupping in the distal femur.

The diagnosis was copper deficiency.

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