- Rib fracture
- Classic metaphyseal lesion
- Femur fracture
- Skull fracture
- Subdural hematoma
- Diffuse cerebral edema
- Duodenal hematoma
- Hypoperfusion complex
Approach to the differential diagnosis of child abuse injuries:
- Rib fracture – especially posteromedial has high specificity for abuse
- Classic metaphyseal lesion – has high specificity for abuse
- Femur fracture – in < 3 years old without a good history is suspicious for abuse
- Skull fracture – if complex has moderate specificity for abuse
- Subdural hematoma – determining its age can be challenging
- Diffuse cerebral edema – is not specific for abuse
- Duodenal hematoma – suspect this in abused child who is vomiting with feeding
- Hypoperfusion complex – is marker of hypovolemic shock
Note: skeletal survey should be repeated after 2 weeks in < 2 years old as rib fractures + classic metaphyseal lesions can be initially subtle and only seen on later imaging