Rofo 2013; 185(7): 670-672
DOI: 10.1055/s-0033-1335266
Der interessante Fall
© Georg Thieme Verlag KG Stuttgart · New York

Radiological Evidence of Rickets in a Lithuanian Child Mummy

S. Panzer
,
A. Tamošiūnas
,
R. Valančius
,
R. Jankauskas
,
D. Piombino-Mascali
Further Information

Publication History

26 October 2012

07 March 2013

Publication Date:
21 May 2013 (online)

Case report

This report concerns a female child mummy ([Fig. 1]) discovered in the Dominican Church of the Holy Spirit, Vilnius, Lithuania. The church stands over a number of subterranean chambers holding mummified human remains most likely dating from the 18th – 19th century AD.

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Fig. 1 Photograph of the Lithuanian child mummy. The mummy is thought to be the result of spontaneous mummification due to the cold and dry environment of the crypt.

Abb. 1 Fotografie der litauischen Kindermumie. Alles weist darauf hin, dass die Mumie das Resultat einer spontanen Mumifikation durch die kalte und trockene Umgebung in der Gruft ist.

Within the framework of the “Lithuanian Mummy Project” (Jankauskas R, Piombino-Mascali D. Paleopath Newsl 2012; 159: 12) the mummy underwent whole-body computed tomography (CT) (Mx8000 Dual, Philips, Best, The Netherlands).

The total length of the body was approximately 74 cm. The age at death was estimated at three to four years based upon an assessment of the stage of dental eruption and the development of carpal bones.

The mummy revealed excellent preservation of the skeleton with few post-mortem dislocations and marked shrinkage of the surrounding tissues. Only sparse preservation of the internal organs was identified.

The skull showed disproportion with widening of the parietal, occipital and temporal bones compared to the facial and frontal bones ([Fig. 2], [3a, b]). Thickening of the vault at the eminences of the frontal and parietal bones was detected ([Fig. 3c]) as well as circumscribed thinning of the tabula interna (impressiones digitatae) of the parietal, temporal and occipital bones ([Fig. 3 d]). In the occipital bone four small defects with thinning of the adjacent inner surface of the vault were detected ([Fig. 3 d]).

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Fig. 2 Anteroposterior scout image of the CT examination giving an overview on the excellent preservation status of the skeleton. The skull showed disproportion and circumscribed thinning of the tabula interna. The lower extremities revealed deformities resulting in a slight form of dwarfism. Both femora showed coxa vara and marked anterior bending. The tibia and fibula were markedly curved anteriorly and laterally with medial tilting of the distal growth plate of the tibia on the left side.

Abb. 2 Anteroposteriores Topogramm der CT Untersuchung mit Überblick über den hervorragenden Erhaltungszustand des Skelettes. Der Schädel zeigte eine Disproportion und umschriebene Ausdünnung der Tabula interna. Die untere Extremität wies Deformitäten auf, die zu einem geringfügigen Zwergwuchs führten. Beide Femora ließen eine Coxa vara und eine deutliche anteriore Biegung des Schaftes erkennen. Tibia und Fibula waren deutlich nach anterior und lateral gebogen, auf der linken Seite war die distale tibiale Wachstumsfuge nach medial verkippt.
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Fig. 3 CT anomalies of the skull. a Anterior view and b lateral view of the 3 D reconstruction illustrate disproportion of the skull with widening of the parietal, occipital and temporal bones compared to the facial and frontal bones. c Paraxial multi-planar reconstruction (MPR) of the skull demonstrating thickening of the cranial vault at the eminences of the frontal bones (arrows). d Paraxial MPR of the skull showing circumscribed thinning of the tabula interna (impressiones digitatae) of the temporal and occipital bones. The occipital bone revealed small defects with thinning of the adjacent inner surface of the vault (arrows). Note the remnants of brain in c and d (dotted arrows).

Abb. 3 CT Besonderheiten des Schädels. a Die anteriore und b laterale Ansicht der 3 D Rekonstruktion veranschaulichen die Disproportion des Schädels mit Verbreiterung des Os parietale, occipitale und temporale gegenüber dem Os frontale und dem Gesichtsschädel. c Paraaxiale multiplanare Rekonstruktion (MPR) des Schädels mit Darstellung der verdickten Schädelkalotte beidseits am Höcker des Os frontale (Pfeile). d Paraaxiale MPR des Schädels mit Illustration der umschriebenen Ausdünnung der Tabula interna (impressiones digitatae) an Os temporale und Os occipitale. Das Os occipitale wies kleine Defekte mit Ausdünnung der angrenzenden Kalotteninnenseite auf (Pfeile). Zu beachten sind die Überreste von Hirngewebe in c und d (gestrichelte Pfeile).

The spine revealed bone-within-bone appearance in the thoracic, lumbar and sacral vertebral bodies ([Fig. 4a]) as well as in the pelvic bones ([Fig. 4b]) and impliedly in the talus and calcaneus.

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Fig. 4 Bone-within-bone appearance. a Sagittal MPR of the spine illustrates the appearance of a miniature vertebral body that conforms in its contours to its larger host in the middle and lower thoracic spine as well as the lumbar and sacral spine. b Paraxial MPR of the pelvis demonstrates analogous findings in the ischium (arrows).

Abb. 4 „Bone-within-bone“ Erscheinungsbild. a Sagittale MPR der Wirbelsäule mit Darstellung des Erscheinungsbildes einer Wirbelkörperminiatur, die sich an die Kontur des Ausgangswirbelkörpers anpasst, erkennbar in der mittleren und unteren Brustwirbelsäule, der Lendenwirbelsäule und dem Sakrum. b Paraaxiale MPR des Beckens mit Illustration des entsprechenden Befundes im Os ischium (Pfeile).

The neck of both femora was bent downwards producing coxa vara. The normal anterior bending of both femora was more marked and slight lateral bowing was discerned. The tibiae and fibulae were markedly curved anteriorly and laterally with medial tilting of the distal growth plate of the tibia on the left side. Femora and tibiae revealed widening of the cortices on the concave side, thickening of the cortical layer and narrowing of the marrow cavities ([Fig. 2]).