Friday, July 3, 2009


This is an AP x-ray of a 2 year old child who has delayed closure of the fontanelles, some parietal and frontal bossing, and soft skull bones. You see odd beading along the anterolateral aspects of the chest. Laboratory tests show elevated alkaline phosphatase.

Challenge: What's the diagnosis?

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tree said...


Craig Chen said...


This is rickets due to deficient mineralization of bone at the growth plate; it often occurs with osteomalacia (impaired mineralization of the bone matrix). Rickets can be caused by calcium or phosphate deficiency. Rickets manifests first at the distal forearm, knee, and costochondral junctions. The chest beading is enlargement of the costochondral junctions and often called the "rachitic rosary." The x-ray shows genu varum and decreased bone opacity.

Sources: UpToDate; Wikipedia.