Presentation
Blunt trauma to the upper limbs. Request for exclusion of bone injury. There is an unknown background syndromic congenital disorder.
Patient Data
There are no acute post-traumatic fractures, dislocations, or subluxations of the upper limbs.
A dysplastic left radius with an absent thumb is identified.
The right upper limb, left shoulder, and left humerus appear normal.
An incidental ingested foreign body, specifically a coin, within the proximal thoracic esophagus is identified on the right upper limb view (modified window). The child was recalled for dedicated chest X-rays.
An incidental finding of an ingested foreign body, specifically a coin, is within the proximal thoracic esophagus.
Incidentally, there are 13 pairs of ribs and suspected T8 butterfly and T9 right hemivertebra with expected AP skeletal symmetry.
There is a normal cardiomediastinal contour.
Dedicated preoperative wrist and hand views were done at a subsequent visit for surgical planning.
There is a dysplastic left radius, which is shortened, with an irregular distal radial metaphysis and a suspected absent distal radial epiphysis. There is a complete absence of the left thumb (absent the first metacarpal, proximal, and distal phalanges). There is a radial deviation of the left wrist and hand.
There is a shortened left ulna with mild bowing, proximal hypertrophy, and an irregular distal metaphysis.
The left forearm is shortened.
Image courtesy of Dr. S. Palliam.
Case Discussion
An example of a type II radial dysplasia with a hypoplastic and shortened radius with an absent distal ossification center 1. The thumb is completely absent.
In view of the congenital thoracic skeletal abnormalities also found incidentally at presentation, the patient was referred for further dedicated workup and diagnosis of the possible underlying congenital syndromic disorder, which is likely present.
The incidental non-witnessed ingested foreign body (coin) was removed by the pediatric surgeons.
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