case_images: PMC3935259_01
case_images: Case 1: 3-month-old male child presenting with symptoms of pallor, abdominal distension, petechial rashes, and recurrent respiratory infections later diagnosed with congenital leukemia. X-ray of both knees and legs, shows diffuse osteopenia with prominent metaphyseal zones (arrows).
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case_images: F1
case_images: Skeletal survey (X-ray) requisitioned to rule out congenital infections revealed diffuse osteopenia and prominent calcific zone at metaphyseal ends of the long bones [Figure 1].
case_images: Case 1: 3-month-old male child presenting with symptoms of pallor, abdominal distension, petechial rashes, and recurrent respiratory infections later diagnosed with congenital leukemia. X-ray of dorsolumbar spine shows osteopenia with prominent vertebral end plates (arrows).
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case_images: PMC3935259_01_JCIS-3-58-g003.jpg
case_images: F2
case_images: Radiograph of the dorsolumbar spine showed osteopenia with prominent vertebral end plates [Figure 2].
case_images: Case 1: 3-month-old male child presenting with symptoms of pallor, abdominal distension, petechial rashes, and recurrent respiratory infections later diagnosed with congenital leukemia. Ultrasound abdomen shows enlarged liver of 7.52 cm in craniocaudal span with diffuse and homogeneously increased echogenicity (arrow).
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case_images: PMC3935259_01_JCIS-3-58-g004.jpg
case_images: F3
case_images: Abdominal sonography revealed hepatomegaly and increased hepatic echogenicity [Figure 3].
case_images: Case 1: 3-month-old male child presenting with symptoms of pallor, abdominal distension, petechial rashes, and recurrent respiratory infections later diagnosed with congenital leukemia. Magnetic resonance imaging (MRI) of the pelvis in coronal plane using short tau inversion recovery (STIR) sequence, shows increased marrow signal intensities in both iliac bones (R x L) (arrows).
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case_images: PMC3935259_01_JCIS-3-58-g005.jpg
case_images: F4
case_images: Magnetic resonance imaging (MRI) of the lumbosacral spine and pelvis, revealed abnormal marrow signal intensities in bilateral iliac bones [Figure 4].
case_images: Case 1: 3-month-old male child presenting with symptoms of pallor, abdominal distension, petechial rashes, and recurrent respiratory infections later diagnosed with congenital leukemia. Bone marrow aspirate from the iliac bone (Leishman stain, 40 x) shows numerous immature lymphoblasts (black arrows).
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case_images: F5
case_images: Bone marrow biopsy from the iliac bones revealed marrow infiltration with immature lymphoblasts and diagnosis of acute lymphoblastic leukemia was confirmed [Figure 5].
case_images: PMC3935259_02
case_images: Case 2: 3-month-old male child presenting with symptoms of pallor, abdominal distension, and recurrent respiratory infections later diagnosed with osteopetrosis. Frontal radiograph of right femur shows diffuse increase in bone density with flared metaphysis (arrow). A "Bone within a bone" appearance is also observed (curved arrow).
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case_images: PMC3935259_02_JCIS-3-58-g007.jpg
case_images: F6
case_images: Radiographs in this patient revealed diffusely increased bone density with loss of medullary cavity in the long bones [Figures 6 and 7]. A 'bone within bone' appearance was also noted in the ends of long bones [Figure 6].
case_images: Case 2: 3-month-old male child presenting with symptoms of pallor, abdominal distension, and recurrent respiratory infections later diagnosed with osteopetrosis. Lateral radiograph of spine reveals sclerosis of vertebral bodies (curved arrow) with relative central lucency (arrows); a characteristic "sandwich vertebra" appearance.
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case_images: PMC3935259_02_JCIS-3-58-g008.jpg
case_images: F7
case_images: Radiographs in this patient revealed diffusely increased bone density with loss of medullary cavity in the long bones [Figures 6 and 7]. Radiograph of dorsolumbar spine showed increased density of the vertebral body with central linear lucency giving the appearance of 'sandwich vertebra' [Figure 7].
case_images: Case 2: 3-month-old male child presenting with symptoms of pallor, abdominal distension, and recurrent respiratory infections later diagnosed with osteopetrosis. Frontal radiograph of skull shows increased bone density with prominent sclerosis of skull base (arrows).
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case_images: F8
case_images: Radiograph of the skull revealed marked sclerosis of the skull base [Figure 8].
case_images: Case 2: 3-month-old male child presenting with symptoms of pallor, abdominal distension, and recurrent respiratory infections later diagnosed with osteopetrosis. Noncontrast computed tomography (NCCT) head shows sclerosis of skull base (Solid arrow). Brain parenchyma and ventricular system are normal.
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case_images: PMC3935259_02_JCIS-3-58-g010.jpg
case_images: F9
case_images: Computed tomography (CT) of the brain done with adequate body lead shielding and using minimal dose, did not reveal any hydrocephalus or cranial nerve compression [Figure 9].
case_images: Case 2: 3-month-old male child presenting with symptoms of pallor, abdominal distension, and recurrent respiratory infections later diagnosed with osteopetrosis. Bone marrow biopsy (H and E stain, x20) shows, disorganized bony trabaculae and obliteration of marrow spaces (black arrows).
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case_images: F10
case_images: Bone biopsy revealed disorganized bony trabaculae with obliteration of marrow spaces, which confirmed the diagnosis of OP [Figure 10].