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. Read More

Meeting name: SPR 2026 Annual Meeting , 2026

Authors: Galvis Ingrid, Kvist Ola, Jarrett Delma

Keywords: Musculoskeletal, Metabolic Disorder, Paediatric Radiology

Learning Objectives: -To recognize age-specific radiographic manifestations of rickets and understand how imaging features evolve from infancy through adolescence. -To distinguish between nutritional, genetic, and systemic causes of rickets using characteristic imaging patterns. -To identify common mimics of rickets and differentiate them from true metabolic bone disease. -To understand the complementary roles of radiography and MRI in challenging cases. Background: Rickets is a pediatric metabolic bone disorder characterized by imaging features that change according to the patient's age and underlying cause. Some conditions may mimic rickets due to similar radiologic features; therefore, accurate recognition of hallmark radiographic signs—including metaphyseal fraying, cupping, widening, and angular deformities—is critical for timely diagnosis, appropriate management, and differentiation from mimics. Nutritional rickets remains the most prevalent cause, particularly among exclusively breastfed infants without adequate vitamin D supplementation. However, older children with rickets frequently have genetic and systemic causes, such as renal and phosphate metabolism disorders. Although radiographs remain the principal imaging modality for evaluation, MRI may provide enhanced diagnostic precision in challenging or unclear cases. Clinical red flags warranting imaging evaluation include persistent or worsening bowing beyond expected physiologic ages, motor delays, pathologic fractures, failure to thrive, and lack of response to vitamin D supplementation in older children, which suggests genetic or renal etiologies rather than simple nutritional deficiency. This educational poster presents an age-based approach to diagnosing rickets, illustrating classic radiographic features across different age groups and etiologies. Key imaging findings in nutritional rickets, hypophosphatemic rickets, and renal osteodystrophy are systematically compared. Common mimics—including scurvy, non-accidental trauma, Blount's disease, osteogenesis imperfecta, and physiologic variants—are reviewed with comparative imaging to enhance diagnostic accuracy. Emphasis is placed on pattern recognition, and the role of advanced imaging in equivocal cases. Read More

Meeting name: SPR 2026 Annual Meeting , 2026

Authors: Galvis Ingrid, Kvist Ola, Vo-phamhi Jenny, Perdomo-luna Camilo, Jarrett Delma

Keywords: Metabolic Disorder, Musculoskeletal, Paediatric Radiology