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An 11 month old girl with bilateral wrist swelling

BMJ 2008; 337 doi: (Published 06 November 2008) Cite this as: BMJ 2008;337:a2149
  1. R Hodgkinson, specialist trainee year 2, paediatrics1,
  2. D S Urquhart, specialist registrar, paediatric respiratory medicine1,
  3. L Thia, specialist registrar, paediatric respiratory medicine1,
  4. S Padley, consultant radiologist2,
  5. A Bush, professor of paediatric respiratory medicine1,
  6. Atul Gupta, specialist registrar, paediatric respiratory medicine1
  1. 1Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London SW3 6NP
  2. 2Department of Radiology, Royal Brompton Hospital
  1. Correspondence to: A Gupta atulgupta{at}

    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.

    Fig 1 Wrist radiograph of an 11 month old girl with bilateral wrist swelling


    • 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?


    Fig 2 Wrist radiograph showing splaying, cupping, and widespread demineralisation

    Fig 3 Chest radiograph showing prominent costochondral joints (rachitic rosary)

    • 1. The growth plate is widened and irregular (an abnormality known as fraying). …

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