Fractures of varying ages in a pediatric 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 pediatric 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.