An 8 year old Indian male presented to outpatient department for mesomelic shortening of upper extremity. Bilateral upper limb radiograph was sent for reporting and clinical details were insufficient. The detail clinical history and clinical examination was done in the radiology department which revealed micropenis, hypertelorism, midface hypolasia, gum hypertrophy, anteverted nares, tented upper lip. Skeletal survey was done which showed costovertebral segmentation anamolies. Our aim is to emphasize the role of history taking and clinical examination by the concerned radiologist in radiology practice.