Presentation
Dyspnoeic episodes ?pneumonia
Patient Data
The patient is rotated to the right which accounts for the differential translucency of the hemithoraces. There is perihilar, peribronchial thickening consistent with airway inflammation. This can be seen in the setting of bronchiolitis.
There is callous formation in the left 4th to 7th ribs anterolaterally in keeping with healing fractures. Irregularity of the left 5th and 6th ribs anterolaterally concerning for further acute/subacute fractures.
Case Discussion
Fractures of varying ages in a paediatric patient without a correlative history are concerning for non-accidental injury. There was no history of trauma in this case, and subsequent evaluation revealed additional injuries to the child.
Non-accidental injury can be detected on imaging investigations performed for other reasons, as is the case with this child x-rayed for possible pneumonia. Radiologists and radiographers must be vigilant in reviewing paediatric studies for the presence of underlying abnormalities which may herald non-accidental injury.
Cases of suspected physical abuse should be discussed with the referring team as a matter of urgency.
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