Preschooler with a palpable midline abdominal mass

Surgical image of rhabdomyosarcoma of the bladder — Surgical image shows the mass (between the surgeon’s fingers) to be extraperitoneal in location, originating from the left posterior aspect of the dome of the bladder. The mass did not appear to invade any normal structures except where it originated in the bladder, which is along the inferior edge of the image.

The diagnosis was rhabdomyosarcoma of the bladder.

Pediatric Imaging Pearl of the Week

View the illustrated DDX of pediatric elbow fractures

School ager who fell from a tree

Radiograph of supracondylar elbow fracture — AP (left) and lateral (right) radiographs of the elbow show a fracture through the humeral metaphysis, above the condyles, along with elevation of the anterior fat pad on the lateral view.

The diagnosis was supracondylar elbow fracture.

School ager who fell off the monkey bars

Radiograph of radial head elbow fracture and olecranon elbow fracture — AP (upper left) and oblique (below) radiographs of the elbow show a complete fracture of the radial head with dislocation of the fracture fragment. Lateral radiograph (upper right) shows a lucency through the olecranon and elevation of the anterior fat pad.

The diagnosis was radial head elbow fracture and olecranon elbow fracture.

Toddler with elbow pain after fall

Radiograph of olecranon elbow fracture — Lateral (above) and oblique (below) radiographs of the elbow show a lucency through the olecranon best seen on the oblique view along with elevation of the anterior and posterior fat pads.

The diagnosis was olecranon elbow fracture.

Preschooler who fell with elbow pain

Radiograph of lateral epicondyle elbow fracture — AP (left) and lateral (right) radiographs of the elbow show a fracture through the lateral epicondyle and elevation of the anterior and posterior fat pads on the lateral view.

The diagnosis was lateral epicondyle elbow fracture.

School ager with elbow pain after falling on their arm

Radiograph of occult elbow fracture — AP (left) and lateral (right) radiographs of the elbow show elevation of the anterior fat pad on the lateral view. No fracture line is seen.

The diagnosis was occult elbow fracture.

School ager with left medial epicondyle pain after a fall

Radiograph of medial epicondyle elbow fracture — AP (upper left) and lateral (upper right) radiographs of the left elbow show inferior displacement of the medial epicondyle on the AP view and posterior displacement of the medial epicondyle and elevation of the anterior fat pad on the lateral view. The normal right elbow (below) is provided as a control.

The diagnosis was medial epicondyle elbow fracture.

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View the illustrated DDX of pediatric elbow fractures

Newborn with a posterior sacral mass noted on prenatal US

Clinical image of sacrococcygeal teratoma — Clinical image shows a large exophytic soft tissue mass in the region of the sacrum.

The diagnosis was sacrococcygeal teratoma.

Pediatric Imaging Pearl of the Week

View the illustrated DDX of Salter-Harris fractures

School ager who tripped and fell, heard a pop, and then developed left hip pain

Radiograph and CT of slipped capital femoral epiphysis — AP radiograph of the pelvis (upper left) shows the left femoral metaphysis to be displaced laterally from its epiphysis. This is better demonstrated on the coronal CT without contrast of the pelvis (upper right) and 3D CT of the pelvis (below)

The diagnosis was slipped capital femoral epiphysis (Salter-Harris Type I fracture) of the left femur.

School ager who hit his finger while sliding into second base at a baseball game

Radiograph of Salter-Harris Type IV fracture of the proximal aspect of the middle phalanx — AP radiograph of the hand shows a linear lucency in the fourth middle phalanx extending from the metaphysis through the physis and into the epiphysis. There is associated cortical irregularity along the medial aspect of the metaphsis.

The diagnosis was Salter-Harris Type IV fracture of the proximal aspect of the middle phalanx of the 4th finger.

School ager who stubbed their first toe and now has pain there

Radiograph of Salter-Harris Type II fracture of the distal phalanx — AP (left) and lateral (right) radiographs of the first toe show soft tissue swelling around the toe and a small bone fragment in the center of the distal physis anteriorly.

The diagnosis was a non-displaced Salter-Harris Type II fracture of the distal phalanx of the first toe.

Teenager with lateral malleolus pain after a motor vehicle accident

Radiograph of Salter-Harris Type I fracture of the distal fibula — AP radiograph of the ankle shows a tremendous amount of swelling of the lateral malleolus with the apex of the swelling centered on the distal fibular physis. There is a small bony fragment near the physis as well thought to be from an avulsion injury.

The diagnosis was a Salter-Harris Type I fracture of the distal fibula.

Teenager who developed pain over the left 5th metatarsal while playing volleyball

Radiograph of apophyseal fracture of the fifth metatarsal — AP radiographs of the feet show asymmetrically increased fragmentation of the left fifth metatarsal apophysis when compared to its counterpart on the right. This was also the point of maximal tenderness on physical exam.

The diagnosis was an apophyseal fracture of the fifth metatarsal.

Teenager with wrist pain after a fall

Radiograph of Salter-Harris Type II fracture of the radius — Lateral radiograph of the wrist shows a fracture through the radial physis and extending up into the radial metaphysis.

The diagnosis was a Salter-Harris Type II fracture of the radius.

School ager baseball player with shoulder pain

Radiograph of Littler Leaguer's shoulder — AP radiograph of the shoulder shows widening of the lateral aspect of the physis.

The diagnosis was Little Leaguer shoulder.

Our DDX For This Week Is

View the illustrated DDX of Salter-Harris fractures

Female infant with a right ovarian cyst on prenatal ultrasound and an incidental abdominal calcification noted on a CXR

Surgical image of ovarian torsion — Surgical image shows a large circular and soft mass that was adherent to, but not invading, the hepatic flexure, omentum, and distal ileum and which was no longer connected to any pelvic structures. There was no ovarian tissue in the right adnexa. The left ovary was normal.

The diagnosis was ovarian torsion that most likely occured in-utero.

Pediatric Imaging Pearl of the Week

View the illustrated DDX of incomplete fractures

Preschooler who fell on an outstretched hand

Radiograph of torus fracture — AP (left) and lateral (right) radiographs of the wrist show cortical irregularities along the medial and lateral borders of the radius and along the lateral and posterior borders of the ulna.

The diagnosis was a torus fracture of the radius and ulna.

School ager with trauma to the forearm

Radiograph of greenstick fracture — AP (right) and lateral (left) radiographs of the forearm show incomplete fractures of the ulnar and radial diaphyses with a moderate amount of angulation.

The diagnosis was a greenstick fracture of the radius and ulna.

School ager with trauma to the forearm

Radiograph of bowing fracture of the radius — Lateral radiograph of the forearm shows a moderate amount of bowing of the radius.

The diagnosis was a bowing fracture of the radius.

Preschooler run over by a riding lawnmower

Radiograph of complete fracture of the femur — AP (left) and lateral (right) radiographs of the femur show a complete fracture of the femoral diaphysis whose fracture fragments are significantly displaced.