A 4 month old African girl presented to the accident and emergency department with a two day history of fever, cough, and poor feeding. She was born full term at a weight of 3000 g. She had no neonatal complications. She was exclusively breast fed and her mother had no history of serious illness. On examination, she had fever, tachypnoea, and tachycardia. Her oxygen saturation was 96% on air. Fine crepitations were heard at the bases of her lungs. A gallop rhythm was detected on cardiac auscultation. Her liver was 2 cm palpable. She had swollen but non-tender wrists. Her full blood count and liver function tests were normal except for an alkaline phosphatase of 942 U/l. Her calcium was 1.5 mmol/l and phosphate 2.16 mmol/l. Radiography of the chest and right wrist was performed (fig 1⇓). Fig 1 Chest radiograph (left) and radiograph of the right wrist (right) ### 1 What are the radiological findings? #### Short answer The chest radiograph (fig 2⇓) shows cardiomegaly and pulmonary plethora. The wrist radiograph (fig 2⇓) shows widening, cupping, and fraying of the epiphysis of the right radius and ulna suggestive …