Differential diagnosis of child abuse injuries

• 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