Dr jpasst profichmchkottayam The manifestations of rickets are most pronounced with rapid bone growth particularly the distal radius and ulna distal femur proximal tibia proximal ID: 289873
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Slide1
Rickets- radiology
Dr
jp,asst
prof,ich,mch,kottayamSlide2
The manifestations of rickets are most
pronounced with
rapid bone
growth
particularly the distal radius and ulna, distal femur
, proximal
tibia, proximal
humerus
, and anterior rib endsSlide3
The
initial radiographic finding in rickets is loss of
mineralization of
the zone of provisional
calcification
loss
of definition
of the Laval-
Jeantet
collar, a short
cylindricalsegment
of the
metaphysis
adjacent to the growth plate
that is
an indicator of the most recently formed bone in
young infantsSlide4
Deficient
chondrocyte
terminal differentiation
and apoptosis
causes accumulation of disorganized cartilage in
the
metaphysis
in addition to
nonmineralized
osteoid
, leading
towidening
of the distance between the epiphysis and
metaphysis,metaphyseal
fraying, and
metaphyseal
concavity (cupping
).Slide5
Metaphyseal
concavity varies by site, being most pronounced in the distal forearm bonesSlide6
Distal
ulnar
metaphyseal
concavity with no other
abnormality should
be recognized as a normal finding.
Metaphyseal
findingsthat
may be recognized on chest radiographs
include involvement
of the proximal humeral
metaphyses
and
rib ends
, producing the rachitic rosarySlide7
Vitamin
D deficiency rickets
.
The initial image (
left) shows loss of definition of the zones
of
provisional
calcification for the distal radial and
ulnar
metaphyses
along with
metaphyseal
fraying and concavity (“cupping”) and
physeal
widening with
an increased distance between the epiphysis and
visualized portion
of the
metaphysis
.
Periosteal
new bone also is present that is
seen best
along the metacarpals but also is present along the distal
radius.
With
healing (
right), the zone of provisional calcification is well
mineralized
and
the other findings have resolvedSlide8
Anteroposterior
(A) and lateral (B) chest radiograph views in a 5-month-old child with rickets from
biliary
atresia
. Note rickets in
the proximal
humeral
metaphyses
and anterior rib ends. The rib findings are best seen on the lateral viewSlide9
less severe case of Vitamin D deficiency
rickets.
At 9½ years of age (
top), distal femoral
physeal
widening and
metaphyseal
fraying is noted that resolved several months
later after treatment (
bottom).Slide10
Diaphyseal
findings in a patient with severe vitamin
D deficiency
rickets. During the active phase (
A), coarse
demineralization
and
subperiosteal
bone
resorption
are present, which are indicative
of hyperparathyroidism
as a result of rickets. Also note the severe
rachitic findings
in the
metaphysis
and poor mineralization of the distal
radial epiphysis
with loss of the zones of provisional calcification (
arrow).
With
healing
3 months later (
B), extensive
periosteal
new bone is seen (
white
arrows) with calcification of previously
nonmineralized
osteoid
(
black arrows
) produced by
periosteal
osteoblastsSlide11
Key points
The initial radiographic finding in rickets is loss of
mineralization of
the zone of provisional
calcification
Isolated distal ulnar
metaphyseal
cupping is a
normal variant
in an infant and should not be confused
with rickets
Ref:
caffeys
pediatric diagnostic
radiology 2013.