Hurler syndrome is differentiated from Morquio syndrome radiographically in the spine due to the presence of inferior rather than central vertebral body "beaks." Pedicles tend to be narrow. A gibbus deformity is observed at the thoracolumbar junction.
In the chest, the rib deformity has been described as resembling a "spatula," due to the thick lateral ribs. Notice the hepatosplenomegaly on the lateral radiograph.
In the pelvis, the iliac wings are flared with inferior tapering. Protrusio acetabulae is occasionally observed (not shown here). The sacrosiatic notches tend to be angular. Femoral necks also are narrow.