Case contributed by Dalia Ibrahim
Diagnosis probable


Abnormal chest configuration.

Patient Data

Gender: Male

Widening of the costochondral junctions (rosary beads appearance).

Pigeon chest deformity (the weak ribs are pulled inwards by the respiratory muscles with anterior protrusion of the sternum) giving a triangular chest appearance on cross section 

Normal CT scan of both lungs.

Widening, cupping and fraying of the proximal humeral metaphsysis.

Lateral bowing of proximal ulnar shafts on both sides.

Case Discussion

Thoracic changes in rickets include:

  • prominent costochondral junctions giving the (rosary beads appearance)
  • pigeon chest deformity with inward displacement of the weak soft ribs and anterior protrusion of the sternum
  • pectus excavatum
  • Harrison's sulcus: depression above the subcostal margin at the site of the diaphragm (secondary to pulling of the softened ribs by the diaphragm at inspiration)

Musculoskeletal changes in rickets include:

  • widening and fraying of the metaphysis of long bones
  • generalized osteopenia
  • vara or valga deformities
  • bone bowing

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