Normal metaphyseal variants

(A) Step-off. Note acute angulation (arrow) of the distal femur. (B) Beak. A dense medial projection (arrow) is noted arising from proximal humerus. (C) Proximal tibial cortical irregularity. A slightly raised area with indistinct cortical margins (open arrow) is noted along medial aspect of the proximal tibia. (D) Spur. A discrete longitudinal projection of bone (arrow) that is continuous with the cortex and extends beyond the metaphyseal margin of the base of the fifth metatarsal.