Atomic legacy in the Marshall Islands.

Congenital anterolateral bowing of the tibia is a rare deformity that may lead to pseudarthrosis and risk of fracture. This is commonly associated with neurofibromatosis type 1. In this report, we describe a 15-month old male with congenital anterolateral bowing of the right tibia and associated hallux duplication. This is a distinct entity with a generally favourable prognosis that should not be confused with other conditions such as neurofibromatosis type 1. Previously published cases are reviewed. Background Neurofibromatosis type 1 (NF1) is a common genetic disease with a prevalence of 1 in 3000 individuals in the general population [1]. With NF1 being a relatively common condition, it is not unusual to consider it in the differential diagnosis when a case of anterolateral tibial bowing is identified in a child as this is an associated feature that can progress to pseudarthrosis and a high risk of fracture [1,2]. However bowing of the tibia is not pathognomonic for NF1. Another uncommon condition, congenital anterolateral tibial bowing and polydactyly (CATBP) presents in this manner [3]. CATBP is readily distinguishable from NF1 because of the absence of any neurocutaneous signs and the presence of hallux duplication and associated hand malformations. In this report, we describe a 15-month old boy with CATBP who was unnecessarily investigated because of concerns regarding NF1. This entity needs to be recognized by pediatricians to avoid unnecessary investigations for a neurocutaneous disorder. Case report The patient was born at term by spontaneous vaginal delivery following induction. His growth parameters were all within normal limits for gestational age. It was observed that he had a right lower limb deformity consisting of medial splaying and duplication of the hallux with mild anterolateral bowing of the ipsilateral tibia [Figure 1]. Incidental note was made of radial deviation of the left index finger. The remainder of the physical examination was unremarkable. Specifically, there were no cutaneous manifestations suggestive of NF1 and other neurocutaneous disorders. Radiographs of the leg showed duplication of the first ray on the right. The right tibia was bowed anterolaterally and a medullary cyst was present. No other radiographic abnormalities were noted. The newborn period was otherwise unremarkable and he was discharged from hospital on the third day. The pregnancy had been remarkable for an elevated alpha-fetoprotein level (2.86 multiples of the median (MoM)) as part of the maternal serum screen drawn in the 18th week of gestation. The levels of the two other analytes Published: 23 July 2007 Journal of Medical Case Reports 2007, 1:54 doi:10.1186/1752-1947-1-54 Received: 18 April 2007 Accepted: 23 July 2007 This article is available from: http://www.jmedicalcasereports.com/content/1/1/54 © 2007 Lemire; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.