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Age: 1 month

Sex: Male

Indication: Choking episode

Save ("V")

Case #12


Findings

  • Acute nondisplaced fractures of the right posterior fourth through seventh and tenth ribs
  • Healing nondisplaced fractures of the left lateral fifth and sixth ribs


Diagnosis

  • Nonaccidental trauma (rib fractures)

Sample Report

Acute nondisplaced fractures of the right posterior fourth through seventh and tenth ribs. Healing nondisplaced fractures of the left lateral fifth and sixth ribs. Findings raise the possibility of nonaccidental trauma. Recommend skeletal survey for further evaluation.

No focal airspace disease, pleural effusion, or pneumothorax.

Normal size and contour of the cardiothymic silhouette.


Discussion

  • 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: acute right and subacute left rib fractures in a distribution concerning for child abuse.

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