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Non-accidental injury

Case contributed by Ian Bickle
Diagnosis almost certain

Presentation

Infant brought to A & E by parents. Child is 'flat'. Limited history given.

Patient Data

Age: 3 weeks
Gender: Male
x-ray

Subtle fractures of the left 8th and 9th posterior ribs.

Lungs clear.

Clinical concern of p...

x-ray

Clinical concern of potential non-accidental injury.

Acute minimally displaced fractures of the left 7th and 8th ribs.

No other fracture.

ct

Small intraparenchymal hemorrhage in the left frontal lobe.

ultrasound

Blood layering in the dependent position of the spinal canal at the thoracolumbar junction.

mri

Mildly high T1 signal in the thecal sac at and below the level of the conus, in keeping with subacute hemorrhage.

mri

Hemosiderin overlying the left frontal lobe in keeping with subacute blood products.

FU skeletal survey at 10 days

x-ray

Callus formation at the site of previous rib fractures of the left 8th and 9th ribs.

The remainder of the skeletal survery is normal.

Case Discussion

Non-accidental injury (NAI) is a very serious and stressful aspect of pediatric medicine.

The radiologist plays a crucial role in the assessment process after the concern is raised by the responsible clinician.

Most institutions have imaging protocols for NAI, adherence to which is important.

Certain injuries, such as posterior rib and metaphyseal corner fractures are highly indicative, especially if in conjunction with intracranial hemorrhage.

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