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Imaging in rickets
- 1. JSS Medical College, Mysuru RICKETS -Dr.Shilpa Resident, JSS Medical College ,Mysuru Please visit www.jssmcradiology.com for more Radiology education For more Radiology Education visit www.jssmcradiology.com
- 2. JSS Medical College, Mysuru Introduction It is the childhood equivalent of osteomalacia in the mature skeleton. Symptoms consist of muscle tetany, irritability, weakness, delayed development, small stature, bone deformities and pain. Soft tissue swellings occurring around the growth plates owing to hypertrophied cartilage ex: costochondral bumps (rachitic rosary). Earliest sign : distal ends of radius and ulna. Ulnar growth plate grows more rapidly so manifestations are seen earlier in ulnar growth plate.* *Silvermanfn. dysostoses,miscellaneous syndromes and metabolic abnormalities. Caffey’s padiatric radiology.1993;2:1746
- 3. JSS Medical College, Mysuru In rickets - disordered proliferation of cartilage cells and defective mineralization in zone of provisional calcification. Decreased quantity of calcified osteoid. Owing to a lack of osteoid mineralization the metaphyseal zone of provisional calcification will also be absent radiographically. Bones appear more radiolucent, with coarsened trabecular patterns widened growth plate with irregular, frayed, and cupped metaphyseal margins (paintbrush metaphyses). Bowing deformities, fractures, decreased bony length, scoliosis, and pseudo- fractures are other notable findings. Bulbous enlargement of the costochondral junctions (rachitic rosary) Patho-radiological features:
- 4. JSS Medical College, Mysuru Radiologic features Wrist: 1.Widening of growth plates 2.Irregular margins of metaphysis with widening and cupping. 3.Osteopenia 4.Rarefraction in long bone Skeletal deformity: Skull: Craniotabes Long bones: Bowing(knock knee) Spine: Scoliosis Pelvis: Triradiate pelvis Ribs: Rachitic rosary For more Radiology Education visit www.jssmcradiology.com
- 5. JSS Medical College, Mysuru WIDENING OF GROWTH PLATE • Earliest and specific radiological change • Due to increase in cartilaginoous cell mass Irregular metaphyseal margins occuring due to fraying and disorganisation of spongy bone in the metaphyseal region METAPHYSEAL FRAYING
- 6. JSS Medical College, Mysuru METAPHYSEAL CUPPING AND WIDENING • Protrusion of bulky mass of cartilageneous cells in the zone of hypertrophy into the poorly mineralized metaphysis For more Radiology Education visit www.jssmcradiology.com
- 7. JSS Medical College, Mysuru • EPIPHYSEAL ABNORMALITIES • Osteopenia • Irregular and indistinct borders • Delayed appearance of ossification centres • SHAFT ABNORMALITIES • Rarefaction of shaft due to loss of mineral content • Cortex becomes thin with a coarse texture
- 8. JSS Medical College, Mysuru 1. Generalized osteopenia, 2. Coarse trabecular patterns, 3. Frayed paintbrush metaphyseal margins (arrows), 4. Lack of the zone of provisional calcification, 5. Widening of the physis. GROWTH PLATE ABNORMALITIES For more Radiology Education visit www.jssmcradiology.com
- 9. JSS Medical College, Mysuru CRANIOTABES • Excess osteoid deposition in frontal and parietal regions with posterior flattening of skull due to supine posture of infant • Squared configuration of skull • Demineralisation of skull For more Radiology Education visit www.jssmcradiology.com
- 10. JSS Medical College, Mysuru BOWING OF LONG BONES • Result of displacement of growth centres owing to asymmetrical musculotendinous pull on the weakened growth plate For more Radiology Education visit www.jssmcradiology.com
- 11. JSS Medical College, Mysuru RACHITIC ROSARY • Bulbous enlargement of costochondral junction especially middle ribs • May indent pleural surface or thymic shadow For more Radiology Education visit www.jssmcradiology.com
- 12. JSS Medical College, Mysuru TRIRADIATE PELVIS • Protrusion of hip and spine into the soft pelvis with protrussio acetabuli For more Radiology Education visit www.jssmcradiology.com
- 13. JSS Medical College, Mysuru Thank You For more Radiology Education visit www.jssmcradiology.com