IS Case 372: Child abuse

Nadia F. Yusaf, MD


2009 URMC Imaging Sciences
Publication Date: 2010-03-02

History

Patient is a 5-month-old infant found unresponsive.

Findings

ET tube is at the carina. There are healing fractures of the posterior 8th, 9th and 10th left ribs and of the clavicle. There is also a corner fracture of the right humerus.

Diagnosis

Child abuse

Discussion

Child abuse, also known as non-accidental trauma, results in over 1 million injuries a year in the U.S. and an unfortunate 5000 deaths. Many children are less than 1 year of age, with the majority being less than 6 years old. Rib fractures in children are suspicious for child abuse. Posterior rib fractures are more common in the pediatric population and are secondary to squeezing a child's thorax. Also, metaphyseal corner fractures, a.k.a. bucket handle fractures, are specific for child abuse and are due to pulling a child's extremity. Other fractures concerning for abuse are fractures of the scapula, sternum, spinous process, long bones of non-ambulating infants, and multiple fractures at different stages of healing. In infants, at least 30% of fractures are due to abuse! Other diagnoses, which are much less common, that may appear like child abuse are Menke's syndrome and osteogenesis imperfecta. Outside of skeletal findings, subdural hematomas and retinal hemorrhages are also highly concerning for child abuse.

References

  1. Donnelly LF. Pediatric Imaging: The Fundamentals. Saunders, 2009.

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