An 11 month old girl with bilateral wrist swellingBMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a2149 (Published 06 November 2008) Cite this as: BMJ 2008;337:a2149
- R Hodgkinson, specialist trainee year 2, paediatrics1,
- D S Urquhart, specialist registrar, paediatric respiratory medicine1,
- L Thia, specialist registrar, paediatric respiratory medicine1,
- S Padley, consultant radiologist2,
- A Bush, professor of paediatric respiratory medicine1,
- Atul Gupta, specialist registrar, paediatric respiratory medicine1
- 1Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London SW3 6NP
- 2Department of Radiology, Royal Brompton Hospital
- Correspondence to: A Gupta
An 11 month old girl presented to the paediatric department with a lower respiratory tract infection. She also had failure to thrive and mild motor developmental delay. On examination, she had swollen wrists bilaterally. A radiograph of her right arm is shown below (fig 1)⇓. Her blood results were urea 4.3 mmol/l, creatinine 29 μmol/l, corrected calcium 2.47 mmol/l, alkaline phosphatase 3340 U/l, and phosphate 1.88 mmol/l.
1. Describe the radiological abnormalities shown in fig 1.
2. What is the likeliest cause for the x ray appearance and blood test results?
3. How else might this condition present clinically?
1. The growth plate is widened and irregular (an abnormality known as fraying). …