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  #1  
Old 04-22-2011
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X Ray Floppy child and Hand X ray

A year old boy attended his regular checkup. The child appeared well except floppy/hypotonic. His X ray was abnormal. What is the most likely cause of this child’s condition?




A.
Hypothyroidism
B. Lead poisoning
C.
Parathyroid hyperplasia
D. Familial hypocalciuric hypercalcemia
E. Vitamin D insufficiency

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Old 04-22-2011
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Default abnormal xray?

if the child had a normal xray id say lead poisoning. but this child has an abnormal xray? abnormal how?
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Old 04-22-2011
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oh sorry there it is. the xray took a while to show. is tht lead lining the bones? the bones look stained at the epiphyseal plates and they arents supposed to be stained yet because the child is not supposed to have his epiphyseal plates closed yet.
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Old 04-22-2011
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Default A

Hypothyroidism
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Old 04-22-2011
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Correct Answer This is classical rickets

X ray showing rickets, cupping fraying and osteopenia and all the features of rickets.

The correct answer is E
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hmm..... rickets does cause muscle weakness, but it is supposed to cause thickened wrists and ankles because it softens the growth plates at the ends of a child's bones.
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Default u r rite!

u know what u are rigth.

Rickets, a disease of growing bone, occurs in children only before fusion of the epiphyses, and is due to unmineralized matrix at the growth plates. Because growth plate cartilage and osteoid continue to expand, but mineralization is inadequate, the growth plate thickens. There is also an increase in the circumference of the growth plate and the metaphysis. This increases bone width at the location of the growth plates, causing some of the classic clinical manifestations, such as widening of the wrists and ankles.

sorry....
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Old 04-22-2011
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Default ricket

its rickets
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Old 04-22-2011
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Default

I'm feeling really stupid asking this - but where are the carpal bones on that xray?
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Default

Quote:
Originally Posted by ashishkabir View Post
I'm feeling really stupid asking this - but where are the carpal bones on that xray?
This is a one year old child, his bones are not yet calcified and therefore you don't see the carpal bones.
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Default

Quote:
Originally Posted by ashishkabir View Post
I'm feeling really stupid asking this - but where are the carpal bones on that xray?
i think....

not fully formed because his bone growth is slow due to vit D deficiency which causes low calcium absorption from the intestines, and also because he is only a year old, so his bones are still placed far apart. although in a normal child the carpal bones are supposed to be all there but not fully developed, which can be determined from the rather hypodens picture of the metaphyseal bones (carpal bones). although at this age his epiphyseal plates on his radius and ulna are not supposed to be darkened but due to his rickets, they are. and this caused the ends of his ulna and radius to grow not longitudinally but horizontally, so his has big wrists as can be seen on the soft tissue xray around the bones.
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Old 04-23-2011
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Default Rickets

Yes. Rickets indeed.

The ends of the radius and ulna are expanded, rarefied, and cup shaped and the bones are poorly mineralized. The most common cause of rickets in infants in the United States is inadequate vitamin D intake.

I agree-lead poisoning is also very tempting answer!

In lead poisoning, high concentrations of lead are deposited in growing bone; the greatest concentration of lead deposition occurs in the metaphysis of rapidly growing bones; primarily the distal femur, both ends of the tibia, and distal radii. This appears as opaque lead lines on radiographs.

Bands of increased density at metaphyses of tubular bones (growing bone)

Floppy child and Hand X ray-leadlegs.jpg
click image to enlarge
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