Cruciate ligament developmental variations are frequently encountered in pediatric musculoskeletal imaging. Some of these variations represent normal anatomic variants, whereas others result from pathological development and can result in pain and instability and may be associated with other abnormalities. The purpose of this educational poster is to review developmental variations in cruciate ligament anatomy that result in normal variants as well as congenital disease. The normal prenatal and postnatal development of the cruciate ligaments is reviewed along with the associated stabilizing structures of the joint capsule. Several examples of normal anatomical variants are reviewed and demonstrated (e.g., triple bundle anterior cruciate ligament, variations in origin and insertion). Examples of the most common congenital anomalies are also presented (e.g., isolated absence, combined absence of both cruciate ligaments, hypoplasia, dysplasia of the intercondylar eminence) along with several associated developmental syndromes (e.g., nail-patella syndrome, tibial and fibular hemimelia, congenital knee dislocation). Several critical differential diagnoses (e.g., bucket handle meniscus tears) will be discussed given their impact on patient management. A systematic approach is provided to help differentiate the various causes of abnormal cruciate ligament development using multimodality imaging. When available, longitudinal imaging, physical examination, and arthroscopic correlations are provided for clinical correlation. Possible complications are discussed to provide additional insight into patient care. Guidelines for reporting are provided to support patient care alongside referring providers. After viewing this module, readers will be able to better understand and differentiate cruciate ligament variants and congenital anomalies and better evaluate their impact on the patients for whom they care. Read More

Meeting name: SPR 2026 Annual Meeting , 2026

Authors: Jasinkiewicz Noah, Newman Christopher

Keywords: Knee, Knee MRI, Congenital

Developmental variations of the meniscus are common in pediatric musculoskeletal imaging. These range from normal anatomical variants to anomalies causing pain, instability, and secondary injuries. The purpose of this educational poster is to review developmental variations that result in normal anatomic variants or congenital disease. Normal prenatal and postnatal mensical development is reviewed along with a discussion of the relevant mechanical stabilizers (e.g., intermeniscal and mensicofemoral ligaments, meniscocapsular ligaments, popliteomeniscal fascicles). Sequential embryologic milestones are outlined to demonstrate the formation of the normal meniscal morphology. The role of collagen and vascular organization is discussed to provide insight into the developmental basis of meniscal shape. Normal anatomic variants (including discoid meniscus, ring-shaped meniscus, hypermobile meniscus, and meniscal flounce) are illustrated. Congenital anomalies (including duplication, hypoplasia, and abnormal attachment) are reviewed. Associated developmental anomalies are also discussed (e.g., thrombocytopenia absent radius syndrome, Larsen syndrome, Ellis-van Creveld syndrome). Important differential diagnoses (e.g., bucket handle tears) will be considered that can result in substantial differences in patient management. A diagnostic approach is provided for differentiating the various causes of abnormal meniscal development using radiographic and MR imaging. When available, longitudinal imaging, physical examination, and arthroscopic correlations are provided for diagnostic confirmation. Possible complications, associated abnormalities, imaging considerations, and reporting recommendations are also provided to better support next steps in patient care. Read More

Meeting name: SPR 2026 Annual Meeting , 2026

Authors: Masood Sehban, Newman Christopher

Keywords: Knee, Congenital, Anatomy

Developmental anomalies of the thumb are frequently encountered in pediatric musculoskeletal imaging and are the most common digital anomalies present in the hands. They often result in functional limitations given the role of the thumb in the normal hand function. Radiological evaluation is essential for diagnosis and treatment planning (whether conservative management or surgical correction). The purpose of this educational poster is to review common congenital thumb anomalies ranging from absence to duplication and to provide a diagnostic approach for diagnosing these anomalies. The normal prenatal and postnatal development of the thumb is reviewed with attention on skeletal development along with the associated development of the muscles and tendons. Radiographic, ultrasound, and MR imaging is provided to illustrate the range of tissue anomalies that occur throughout thumb development. Specific examples of abnormal thumb development are discussed and illustrated (e.g., preaxial polydactyly, hypoplasia, triphalangeal thumb). Multiple associated developmental anomalies are also reviewed (e.g., Holt-Oram syndrome, thrombocytopenia absent radius syndrome, arthrogryposis multiplex congenita). A diagnostic approach is provided to help differentiate the various causes of abnormal thumb development using a multimodal imaging approach. When available, longitudinal imaging, physical examination, and surgical correlations are provided for diagnostic confirmation. Possible complications and associated abnormalities are discussed to provide additional considerations for treatment planning. Reporting recommendations are also provided to better facilitate next steps in patient management with the goal of maximizing thumb function. At the end of this module, viewers will be able to better identify and classify thumb anomalies and provide important diagnostic information for guiding patient care. Read More

Meeting name: SPR 2026 Annual Meeting , 2026

Authors: Delos Reyes Mark, Newman Christopher

Keywords: Skeletal Maturation, Hands and Feet, Congenital Hand Anomalies

Fractures are among the most common injuries detected radiologically in cases of suspected child abuse. However, normal developmental variants may resemble fractures on imaging and can pose a challenge for accurate diagnosis. The aim of this educational exhibit is to review normal anatomic variants that can mimic child abuse injuries and outline key imaging features that help distinguish these normal variants from traumatic injuries. Examples from the skull include include accessory sutures and vascular channels, which can mimic linear calvarial fractures. Examples from the thorax include accessory ossification centers, bifid ribs, pseudarthroses, costochondral junction variants, and sternal ossification centers, which can mimic healing rib fractures. Examples from the long bones include metaphyseal collars, cortical stepoffs, metaphyseal spurs, and metaphyseal fragmentation, all of which can mimic classic metaphyseal lesions. Anatomic variants are presented alongside the injuries that they often mimic in order to demonstrate the key imaging features that permit improved discrimination. Further imaging and clinical correlation are provided to demonstrate the benign nature of anatomic variations. A diagnostic checklist is provided for differentiating these variants from fractures in unknown cases. Understanding normal developmental patterns and the radiological appearance of common variants in the pediatric skeleton is critical for the accurate interpretation of imaging studies in order to avoid overdiagnosing fractures that would otherwise cause high concern for child abuse. Read More

Meeting name: SPR 2026 Annual Meeting , 2026

Authors: Alucozai Doonyah, Marine Megan, Karmazyn Boaz, Newman Christopher

Keywords: NAT/Abuse, Musculoskeletal, Anatomy

Genitourinary abnormalities are frequently detected on prenatal imaging. Though many anomalies are easily diagnosed on ultrasound and MR imaging, those that lead to hydrocolpos are not always as easy to distinguish. The purpose of this educational poster is to review the causes of prenatal hydrocolpos and provide an organized approach to differentiate these entities on prenatal imaging. Several examples of ultrasound and fetal MR imaging are provided to illustrate multiple abnormalities that can produce hydrocolpos (e.g., cloacal malformations, persistent urogenital sinus, congenital adrenal hyperplasia, transverse vaginal septum, imperforate hymen, vaginal atresia) and to distinguish other lesions that may mimic hydrocolpos (e.g., sacrococcygeal teratoma, ovarian cyst). A diagnostic approach is provided for differentiating the various causes of hydrocolpos on prenatal imaging. When available, postnatal imaging, physical examination, and endoscopic correlations are provided for diagnostic confirmation or clarification. Complications and associated abnormalities are discussed to provide additional considerations for prenatal evaluation and treatment planning. At the end of this module, viewers will better understand and differentiate the various entities that lead to hydrocolpos on prenatal imaging. Read More

Meeting name: SPR 2023 Annual Meeting & Postgraduate Course , 2023

Authors: Newman Christopher, Forbes-amrhein Monica, Brown Brandon, Marine Megan

Keywords: Hydrocolpos, Cloaca, Urogenital Sinus

Premature infants are at an increased risk of physical abuse. However, the rate of classic metaphysical lesions (CMLs) in premature infants is currently unknown. Therefore, the aim of the current study was to compare the rates of CMLs in premature infants relative to term infants. Read More

Meeting name: SPR 2025 Annual Meeting , 2025

Authors: Okonjo Ethel, Oshodi Connell, Marine Megan, Karmazyn Boaz, Newman Christopher

Keywords: Abusive Injury, Classic Metaphyseal Lesion, Preterm Neonate