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    Case of the Day

    Modality: X-Ray Modality: X-Ray Modality: X-Ray Modality: X-Ray

    View here all images of this case in different sizes !

    Go to the top of the page ID: 20100128133421
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     Available images: There are X-Ray images available for this case. [ X-Ray ]   

    Sanjeeb Kumar Sarma (Down Town Hospital/Guwahati/India)  

     Email Address:

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    3 Years  




    3 years old emaciated male patient brought to our hospital with inability to stand or walk properly.  

     Pathomorphology or Pathophysiology of this disease :

    The skeletal effects of rickets are due to lack of calcification of osteoid. As a result most obvious changes are seen at metaphysis where the most rapid growth occurs. The earliest changes are loss of normal “zone of provisional calcification” adjacent to metaphysis featuring as indistinctness of metaphyseal margin. This progressed to a “frayed” appearance with widening of the growth plate due to lack of calcification of metaphyseal bone. Weight bearing and stress on the uncalcified bone give rise to “splaying” and “cupping” of the metaphysis. A similar but less marked effect occurs in the sub-periosteal layer causing loss of distinctness of cortical margin. Generalized osteopenia occurs, however, looser’s zones are distinctly uncommon.
    In severe cases additional deformities like bowing of long bones particularly of lower bones, thoracic kyphosis with a pigeon chest, enlargement of anterior ribs causing ricketic rosary and bossing of the skull. In low birth weight premature babies features of rickets may be very severe with spontaneous fractures and respiratory difficulty. Affected infants are usually bellow 1000 g in weight or less than 28 weeks of gestation.
    Treatment is dietary supplement of vitamin D.  

     Radiological findings:

    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Splaying, fraying, cupping, widening of growth plates of bilateral distal radius and ulna.

    X-Ray 2 <- view X-Ray 2

    X-Ray 2: Coned down view of right wrist.

    X-Ray 3 <- view X-Ray 3

    X-Ray 3: Lateral view of both wrist showing all the finding as in Fig1.

    X-Ray 4 <- view X-Ray 4

    X-Ray 4: Same findings also noted in bilateral distal femur and proximal tibia and fibula.


     Diagnosis confirmation:

    Expert's opinion  

     Which DD would be also possible with the radiological findings:

    Hypophosphatasia, NAI etc  

     Course / Prognosis / Frequency / Other :

    Prognosis is good with timely intervention.  

     Comments of the author about the case:

    Patient is undergoing treatment.  

     First description / History:





    Generalized diseases  

     Most likely etiology:


     Available images: There are X-Ray images available for this case. [ X-Ray ]   
    More cases from these authors: Search Sanjeeb Kumar Sarma in Medline Sanjeeb Kumar Sarma (8)     

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