of the child revealed features suggestive of mucopolysaccharidosis 1H (Hurler syndrome), which was further confirmed by quantitative and qualitative urinary glycosoaminoglycan (GAG) analysis  revealing elevated levels of dermatan and heparan sulphate.
5,6) The diagnosis is made by excluding multiple myeloma and by the absence of monocional protein in the serum or urine in conjunction with normal findings on both skeletal survey
and bone marrow biopsy.
A radiographic skeletal survey
showed scattered lytic lesions in the proximal right humerus, right scapula, and the distal femurs bilaterally (Figure 2).
Chest radiography confirmed the pneumonia but interestingly a radiographic skeletal survey
revealed severe generalised osteopenia, multiple rib fractures and delayed bone age.
Summary skeletal survey
and whole-body MRI identified 167 fractures or areas of skeletal signal abnormality.
However, white children were more likely to receive a diagnosis of child abuse once a skeletal survey
6g/L and skeletal survey
demonstrated multiple lytic lesions in the skull.
revealed a mildly hyperostotic skull, with mild frontal bossing.
No hypercalcemia was apparent, and a skeletal survey
showed no osteolytic le sions.
His skeletal survey
showed multiple lytic lesions, urine protein electrophoresis demonstrated more than 2 g of free kappa light chains, and a bone marrow aspirate and biopsy demonstrated 68% plasma cells.
Minority children were five times more likely to get a skeletal survey
than were white children.
Doctors carried out a full skeletal survey
and discovered the 32 fractures.