Pediatric hip pain in young athletes encompasses a wide range of disorders related to skeletal immaturity and increasing athletic demands. Timely and accurate diagnosis is important, as delayed recognition may result in growth disturbances, instability, and long-term morbidity. Imaging plays a central role in differentiating clinically significant abnormalities from normal developmental variation and less consequential conditions. This review presents a pattern-based framework for evaluating pediatric hip pathology, organized into key categories based on dominant imaging patterns. Emphasis is placed on imaging findings that influence management and return-to-play decisions, including high-risk features and common pitfalls related to skeletal maturation. This approach provides a practical framework for diagnosis, risk stratification, and effective multidisciplinary communication.
Myositis ossificans circumscripta is a benign, self-limiting heterotopic ossification usually occurring after a traumatic event. Our case describes a rare etiology given the occurrence after vaccination in a child. Indeed, to date, only two cases of myositis ossificans circumscripta after COVID-19 vaccination have been reported, both in adults. In this first pediatric case, radiographs performed at appropriate time allowed for a conclusive tissue characterization and hence diagnosis. CT and MR scans performed early after clinical manifestation showed only progressive, severe edema of the soft tissue of the shoulder while the later acquired radiograph and radiographic follow-up demonstrated the heterotopic ossification in the deltoid. Rapid soft tissue swelling and edema, in correlation with a potential local traumatic event, even if atypical, should raise suspicion of myositis ossificans circumscripta. With proper timing (at least 10 days after the trigger), radiographs can be crucial in showing the typical ossification pattern.
Abstract Artificial intelligence (AI) is increasingly used in radiology. For pediatric patients, the only commercially available computer-aided detection/diagnosis tool currently available is for fracture detection. Here, our experience at a pediatric hospital with a 2-month trial of a commercial AI fracture-detection tool is described. Although the tool was sometimes helpful, particularly for subtle fractures and as confirmatory support in borderline cases, its overall value was limited by cost, false-positive and false-negative results, workflow inconsistency, and the burden of post-deployment monitoring. In our experience, aggregate performance alone did not capture the practical issues most relevant to clinical adoption, including delayed or missing AI results, provider confusion when AI and radiologist interpretations differed, and the infrastructure required for sustainable oversight. Our experience suggests that fracture-detection AI should be evaluated not only by diagnostic performance, but also by real-world clinical utility, workflow reliability, and implementation burden and provides real-word insight into these issues.
Abstract Musculoskeletal ultrasound offers a unique ability to perform dynamic, real-time assessment of musculoskeletal structures during motion, providing functional information that is not available with static imaging modalities. Dynamic ultrasound remains underutilized in pediatric sports-related musculoskeletal evaluation, where skeletal immaturity and pediatric-specific injuries present distinct diagnostic challenges. This review outlines the principles and clinical applications of dynamic ultrasound in the pediatric athlete. Common dynamic assessment techniques in the pediatric population are illustrated across frequently evaluated joints, including the shoulder, elbow, wrist and hand, hip and pelvis, knee, and foot and ankle. Applications include evaluation of joint instability, ligamentous injury, tendon subluxation or snapping, apophyseal avulsion injuries, and motion-dependent conditions. Dynamic ultrasound complements clinical and biomechanical assessment in pediatric athletes. Familiarity with pediatric-specific anatomy, conditions, and dynamic techniques can expand diagnostic confidence and enhance the role of ultrasound in sports-related musculoskeletal imaging.
