MAY 28, 2014 10:30 AM PDT

Early infantile rickets: A new look at an old disease and mimic of child abuse

  • Board Certified Diagnostic Radiologist, Clinical Radiologist, SC
      Dr. David Ayoub is a board certified radiologist with over 20 years of experience in diagnostic radiology. He is a senior partner in Clinical Radiologists, SC, a large private practice multispecialty group practicing in over 35 hospitals and clinics in central and southern Illinois, in affiliation with Southern Illinois University School of Medicine radiology residency. His current interests have been early infantile rickets that mimics child abuse. He recently published a critique in the American Journal of Radiology that proposed rickets likely explained the classic metaphyseal lesion, once thought to be a pathognomonic sign of inflicted skeletal trauma in infants. He has reviewed over 400 cases of unexplained fractures in infants and presented preliminary findings at meetings of the American Society of Bone and Mineral Research and the Radiological Society of North America. His research involves a multidisciplinary approach in collaboration with experts from pediatrics, orthopedic surgery, genetics, endocrinology and child abuse. Current projects include detailing the radiographic findings of the skeletal changes of recovering rickets.


    Early infantile rickets is the least appreciated form of this ancient disease of children. Although it is usually subclinical, the high prevalence recently reported at autopsy (87% < 1 year age) suggests it is far more common than classical presentations and vastly underappreciated. In my experience with living subjects the disease is most often recognized in infants with unexplained fractures undergoing skeletal surveys for suspected child abuse. Classical signs of metaphyseal fraying and splaying are absent, but numerous additional radiographic signs of rickets and hyperparathyroidism are easily recognized. The most common radiographic finding is that of staged rachitic growth plate recovery indicating that extremity fractures occur after initiation of healing. The development of disease is associated with numerous maternal risk factors, particularly vitamin D deficiency and use of antacids. Biochemical testing in the infants is highly variable. Early infantile rickets closely resembles the clinical and radiographic findings of osteopathy of prematurity.

    1) To recognize the clinical signs and risk factors of vitamin D deficiency during pregnancy and early infancy
    2) Describe the range of radiographic changes of rickets in early infancy and how they differ from classical rickets.

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