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Age: 5 months

Sex: Female

Indication: Fever, cough

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Case #44


Findings

  • No focal airspace opacification, pleural effusion, or pneumothorax
  • Normal size and configuration of the cardiothymic silhouette
  • Healing right lateral sixth and seventh rib fractures


Diagnosis

  • Nonaccidental trauma (rib fractures)

Sample Report

No focal airspace opacification, pleural effusion, or pneumothorax.

Normal size and configuration of the cardiothymic silhouette.

Healing right lateral sixth and seventh rib fractures. Findings can be seen with nonaccidental trauma. Recommend skeletal survey for further evaluation.


Discussion

  • It is important to look for signs of nonaccidental trauma even when the clinical team does not suspect it
  • Fracture types that are considered highly specific for child abuse include:
    • metaphyseal corner fractures
    • posterior rib fractures (especially when multiple and bilateral)
    • scapular fractures
    • sternal fractures
    • spinous process fractures
    • clavicle fractures (except when associated with delivery)
  • Fractures of different ages also heighten the concern for nonaccidental trauma


Images

Red arrows: healing right lateral sixth and seventh rib fractures.

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