Rickets is a childhood bone disease caused by vitamin D deficiency and impaired bone mineralization. Symptoms include bone pain, soft tissue swelling, and bone deformities. Radiographically, rickets is characterized by widened growth plates with irregular and frayed metaphyseal margins, cupping of the metaphysis, and generalized osteopenia. Specific findings include craniotabes, bowing deformities of the long bones, rib fractures causing a "rachitic rosary" appearance, and triradiate pelvis. The document provides detailed radiological descriptions and images of findings in rickets.

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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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