sentences:  While the definitive presentation of the disease is a patient having bowed lower limbs and sex reversal in 46,XY males, there are other clinical criteria that can be used, absent these characteristics, to make the diagnosis.Patients may present with underdeveloped shoulder blades, shortened and angulated lower limbs, a vertically oriented and narrow pelvis, an enlarged head, an undersized jaw, cleft palate, flat nasal bridge, low set ears, club feet, dislocated hips, 11 pairs of ribs instead of 12, or bone abnormalities in the neck and spine.Respiratory distress can be caused by an underdeveloped trachea which collapses on inhalation or by insufficient rib cage development.