Non accidental injury

Case contributed by Dr Ian Bickle

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.

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 haemorrhage 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 haemorrhage.

MRI

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

X-ray

Follow up skeletal survey at 10 days

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 paediatric medicine.

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

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

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

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Case information

rID: 34636
Case created: 2nd Mar 2015
Last edited: 29th Aug 2017
System: Paediatrics
Inclusion in quiz mode: Included

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