Common and uncommon imaging features of Rickets have been covered.

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RICKETS
-Dr.Shilpa
Resident,
JSS Medical College ,Mysuru
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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

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 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:

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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
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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

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METAPHYSEAL CUPPING AND
WIDENING
• Protrusion of bulky mass of
cartilageneous cells in the zone of
hypertrophy into the poorly
mineralized metaphysis
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• 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

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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
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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
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BOWING OF LONG BONES
• Result of displacement of growth
centres owing to asymmetrical
musculotendinous pull on the
weakened growth plate
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RACHITIC ROSARY
• Bulbous enlargement of
costochondral junction especially
middle ribs
• May indent pleural surface or
thymic shadow
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TRIRADIATE PELVIS
• Protrusion of hip and spine
into the soft pelvis with
protrussio acetabuli
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Thank You
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