3 Year Old Child With Protein Calorie Malnutrition

An X-ray of chest taken of a child with protein- calorie malnutrition and delayed developmental milestones is shown below.

What bony abnormality is seen in the x-ray from this child ?
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Rachitic rosary.

Discussion:

Rachitic rosary refers to expansion of the anterior rib ends at the costochondral junctions and is most frequently seen in rickets.

Causes of this appearance include: 

• Rickets: nodularity at costochondral junction (rachitic rosary)
• Scury 
  • the costochondral junction is more angular and has a sharper step-off (scorbutic rosary). 
  • the sternum is usually found to be depressed.
• Chondrodystrophy

It is important to consider whether this appearance could actually represent healing fractures as a result of child abuse.

Rickets is a condition in which the growing bones in children are softened and weakened because of extreme and prolonged deficiency of Vitamin D.