1. 1/2 old baby x ray chest AP x ray b/l Forearm unable to sit , standing, walk Diagnosed x ray and suggest more investigation and treatment


all respected doctors excuse me to differ from your opinion of rickets. i agree with the findings of metaphysoepiphyseal region BUT I m concern about intramedullary circumscribed punchedout purely lytic intramedullary lesion throughout the bone. plus over distal humeral region there is periosteal new bone formation. and these purely lytic lesions throughout all the bones of body clinches me to diagnose this as to be LETTERRER SEWE DISEASE a variant of histiocytosis x. points favoring :- age <2years, bony lesions as described. ricketic features here may be due to multisystem involvement. inv:- radiological skeletal survey,bone biopsy,complete hemogram. please correct me and post the diagnosis of this patient. its an interesting case.
mostly it is a case of ricket that too non nutritional. it can b hypophosphatemic rickets . plan I nvestigations with a good pediatrician to rule out renal rickets as well. also post clinical P photo of the pt. as facies helps to rule out OI. take family history examine siblings. plz update the follow up.
Being infantile age, most probably looks like non nutritional rickets. Pls do serum creatinine, serum electrolytes, s. Calcium, s. Phosphorus, SAP, PTH, 25-OH vitamin D and decide
Most probably, it seems to be RICKETS . For work up Do Vitamin D level and then accordingly decide whether it is nitritional or metabolic rickets,

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Rickets. signs s/o rickets. cupping n fraying of jts. cxr rachiatic rosary. plus osteopenia. Do vit D and calcium n phosphorus .
There is no doubt about Rickets but to delineate the cause I have suggested investigation above as well as interpretation chart.
it is rickets, send vit d 3, calcium, phosphate, pth and do abg, mostly it is vitamin d dependent rickets
Severe rickets and possible pem... Prevent pathological fracture and rule out renal abnormality
Vitamin D deficiency rickets with fragile bones scalloping of metaphysis noted
osteogenesis imperfecta most probably with fractures and chest wall deformity
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