Purpose or Case Report: Bowing of the lower extremities is a common presentation in pediatric patients and may represent either normal physiologic development or an underlying pathologic process requiring medical or surgical intervention. Radiologists play an essential role in distinguishing between benign developmental variants and serious bone disorders, including nutritional deficiencies, metabolic bone disease, and skeletal dysplasias. Conditions such as rickets, scurvy, and Blount's disease have distinct etiologies but often present with overlapping radiologic features—most notably metaphyseal abnormalities, osteopenia, and angular deformities—that can obscure diagnosis and delay appropriate treatment.

This educational poster presents a structured, pattern-based approach to evaluating pediatric bowing disorders, integrating clinical presentation, age, and characteristic imaging findings. Key radiographic parameters include the metaphyseal-diaphyseal angle, tibiofemoral angle measurements, and assessment of the Drennan angle for differentiating infantile Blount's disease from physiologic bowing. Age-specific thresholds guide management: physiologic bowing typically resolves by 18-24 months, whereas progression beyond age 2 years or asymmetric involvement warrants investigation for pathologic etiologies. Age-specific diagnostic criteria and systematic assessment of metaphyseal morphology form the foundation of our approach. We highlight key differentiating features for scurvy, rickets (including hypophosphatemic forms), Blount's disease, and other mimickers such as osteogenesis imperfecta and skeletal dysplasias. Emphasis is placed on early recognition of red flags, interpretation of radiographic and MRI findings, and understanding imaging pitfalls that can lead to misdiagnosis. Using comparative imaging examples and diagnostic algorithms, this poster aims to enhance the radiologist's ability to confidently diagnose and differentiate pediatric bowing deformities, improving clinical outcomes and reducing unnecessary interventions.
Methods & Materials:
Results:
Conclusions: