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Toddler who is unresponsive

CT of subgaleal hematoma, diastatic skull fracture, depressed skull fracture, cerebellar contusion, diffuse cerebral edema in child abuse
Axial CT without contrast of the brain shows high density material in the subgaleal tissues posteriorly, a wide lucency in the right posterior skull along with two areas of depressed lucency in the left frontal skull, a rounded high-density lesion in the midline of the cerebellum, and decreased density of the cerebrum when compared to the normal density of the cerebellum along with loss of the normal gray matter-white matter differentiation.

The diagnosis was a posterior subgaleal hematoma, a right posterior diastatic skull fracture and a left frontal depressed skull fracture, cerebellar contusion and diffuse cerebral edema in a child abuse patient.

Toddler who was being swung overhead and was accidentally dropped 6 feet

Radiograph of stellate skull fracture and CT of acute subdural hematoma due to accidental trauma
AP and lateral radiographs of the skull show numerous branching lucencies in the right parietal bone. Axial CT without contrast of the brain shows high density material in the right subgaleal tissues, a small high density cresenteric fluid collection in the right extra-axial space that extends posteriorly along the falx, and a mixed low-density and high density lesion in the right posterior parietal brain parenchyma.

The diagnosis was a right subgaleal hematoma, right acute stellate skull fracture, right acute subdural hematoma with interhemispheric extension, and a right posterior cerebral contusion in a patient with accidental trauma.

Infant with acute and chronic emesis

MRI of acute and chronic subdural hematomas in child abuse
Axial CT without contrast of the brain (upper left) shows bilateral large low density extra-axial fluid collections and a left frontal small high density extra-axial fluid collection. There is also prominence of the cortical sulci and the ventricular system. Axial T1 (upper right), T2 (lower left) and FLAIR (lower right) MRI without contrast of the brain better demonstrates the extra-axial fluid collections with the bilateral large collections being bright on T1 and T2 and the small left frontal collection being iso on T1 and dark on T2.

The diagnosis was bilateral large chronic subdural hematomas with associated cerebral atrophy and a left frontal acute subdural hematoma in a child abuse patient.

Infant with swollen right leg

Radiograph of femur fracture in child abuse
AP radiograph of the right femur shows a lucency through the diaphysis of the right femur with no associated periosteal reaction. CXR AP shows callus formation around the right 7th and 9th ribs laterally, the right 7th-9th ribs posteriorly, the left 3rd-7th ribs laterally and the left 8th rib posteriorly.

The diagnosis was an acute displaced fracture of the right femur and chronic rib fractures of the right 7th and 9th ribs laterally, the right 7th-9th ribs posteriorly, the left 3rd-7th ribs laterally and the left 8th rib posteriorly in a child abuse patient.

Infant who has been shaken

Radiograph of classic metaphyseal lesion / bucket handle fracture / corner fracture of the tibia in child abuse
AP radiograph of the right tibia and fibula (left) shows a faint bucket handle irregularity of the distal tibial metaphysis. Lateral radiograph of the right tibia and fibula (right) shows anterior and posterior corner irregularities of the distal tibia metaphysis.

The diagnosis was a classic metaphyseal lesion (bucket handle fracture / corner fracture) of the distal right tibia in a child abuse patient.

Infant with leg pain

Radiograph of classic metaphyseal lesion / bucket handle fracture of the femur and tibia in child abuse
AP radiograph of the lower extremities shows bucket handle irregularities of the metaphyses of the bilateral distal femurs and bilateral proximal tibiae. There is also periosteal reaction of the distal left femur and bilateral tibiae.

The diagnosis was classic metaphyseal lesions (bucket handle fractures) of the bilateral distal femurs and bilateral proximal tibiae in a child abuse patient.