What should be suspected given the CXR findings?
Multiple rib fractures in an infant or child should raise the suspicion of a non-accidental injury (NAI).
What further investigations should be recommended?
The child should be further investigated with a skeletal survey along with a CT brain.
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.