Rickets or abuse, or both?

Excerpt

Pediatric radiologists are often the first physicians to make the diagnosis of either rickets or child abuse in infants and young children. In a busy pediatric radiology department, these diagnoses are not rare, and appear to be increasing in frequency [1, 2]. At least three issues are not always clear. First, the laboratory values of serum calcium, phosphate and alkaline phosphatase activity are broadly ranging in infants and children [3]. Hence, in an individual patient, the biochemical evidence of vitamin D-deficiency rickets can be problematic. Second, patients with metaphyseal lesions and/or rib fractures are sometimes said to have “pathognomonic findings” of either rickets or abuse [2, 4]. Fractures at these locations are found in a wide variety of inherited and metabolic disorders as well as in cases of trauma [5]. Third, these two conditions are sometimes found together, which I have personally seen. …