Non-accidental Injury

Case contributed by George Harisis


6 month old child, presents unwell with increased work of breathing. ?Respiratory infection.

Patient Data

Age: 6 months
Gender: Male

AP chest x-ray demonstrates a subtle airspace opacity in the right lower zone which may represent early infective/inflammatory changes. Of note, there are healing fractures of the left 4th to 8th posterior ribs along with multiple old bilateral posterior and lateral rib fractures.


Non IV contrast CT brain demonstrates an acute left sided subdural hematoma at the vertex, extending into the falx and layering on the left tentorial leaflet. No skull fracture is identified. The findings are consistent with non-accidental injury. 

Case Discussion

Irrespective of the presenting history, the presence of posterior rib fractures (often of variable age) in an infant or child should raise the suspicion for non-accidental injury, and further investigation with skeletal survey and CT brain should be considered. 

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