Book contents
- Frontmatter
- Dedication
- Contents
- List of Contributors
- Editor’s note on the Foreword to the third edition
- Foreword to the third edition
- Foreword to the second edition
- Foreword to the first edition
- Preface
- Acknowledgments
- List of acronyms
- Introduction
- Section I Skeletal trauma
- Chapter 1 The skeleton: structure, growth and development, and basis of skeletal injury
- Chapter 2 Skeletal trauma: general considerations
- Chapter 3 Lower extremity trauma
- Chapter 4 Upper extremity trauma
- Chapter 5 Bony thoracic trauma
- Chapter 6 Dating fractures
- Chapter 7 Differential diagnosis I: diseases, dysplasias, and syndromes
- Chapter 8 Differential diagnosis II: disorders of calcium and phosphorus metabolism
- Chapter 9 Differential diagnosis III: osteogenesis imperfecta
- Chapter 10 Differential diagnosis IV: accidental trauma
- Chapter 11 Differential diagnosis V: obstetric trauma
- Chapter 12 Differential diagnosis VI: normal variants
- Chapter 13 Evidence-based radiology and child abuse
- Chapter 14 Skeletal imaging strategies
- Chapter 15 Postmortem skeletal imaging
- Section II Abusive head and spinal trauma
- Section III Visceral trauma and miscellaneous abuse and neglect
- Section IV Diagnostic imaging of abuse in societal context
- Section V Technical considerations and dosimetry
- Index
- References
Chapter 7 - Differential diagnosis I: diseases, dysplasias, and syndromes
from Section I - Skeletal trauma
Published online by Cambridge University Press: 05 September 2015
- Frontmatter
- Dedication
- Contents
- List of Contributors
- Editor’s note on the Foreword to the third edition
- Foreword to the third edition
- Foreword to the second edition
- Foreword to the first edition
- Preface
- Acknowledgments
- List of acronyms
- Introduction
- Section I Skeletal trauma
- Chapter 1 The skeleton: structure, growth and development, and basis of skeletal injury
- Chapter 2 Skeletal trauma: general considerations
- Chapter 3 Lower extremity trauma
- Chapter 4 Upper extremity trauma
- Chapter 5 Bony thoracic trauma
- Chapter 6 Dating fractures
- Chapter 7 Differential diagnosis I: diseases, dysplasias, and syndromes
- Chapter 8 Differential diagnosis II: disorders of calcium and phosphorus metabolism
- Chapter 9 Differential diagnosis III: osteogenesis imperfecta
- Chapter 10 Differential diagnosis IV: accidental trauma
- Chapter 11 Differential diagnosis V: obstetric trauma
- Chapter 12 Differential diagnosis VI: normal variants
- Chapter 13 Evidence-based radiology and child abuse
- Chapter 14 Skeletal imaging strategies
- Chapter 15 Postmortem skeletal imaging
- Section II Abusive head and spinal trauma
- Section III Visceral trauma and miscellaneous abuse and neglect
- Section IV Diagnostic imaging of abuse in societal context
- Section V Technical considerations and dosimetry
- Index
- References
Summary
Introduction
The differential diagnosis of the skeletal lesions of child abuse includes a variety of naturally occurring diseases, dysplasias, and syndromes. They may be characterized by fractures, subperiosteal new bone formation (SPNBF), irregular metaphyses, and miscellaneous osseous alterations that suggest a traumatic etiology (Table 7.1). The findings can occur in isolation or in combination, creating complex imaging patterns. In many entities, associated radiologic features allow differentiation from abuse. In most others, proper diagnosis is established by a systematic analysis of the history, clinical, and laboratory findings, in conjunction with the imaging alterations. This chapter discusses a variety of diseases in which the skeletal abnormalities may be a source of potential confusion with child abuse. Rickets, including osteopenia of prematurity (see Chapter 8), osteogenesis imperfecta (see Chapter 9), accidental injuries (see Chapter 10), obstetric injuries (see Chapter 11), and normal variants (see Chapter 12) are covered separately.
Inherited bone dysplasias
The diagnosis of child abuse is sometimes entertained at the initial presentation of infants with inherited bone dysplasias, which are extensively catalogued in the On Line Mendelian Inheritance in Man (OMIM®) with unique phenotype MIM numbers (1, 2). The conditions which can potentially lead to the mistaken diagnosis of child abuse are those with metaphyseal irregularity and fragmentation. Langer and colleagues described a form of spondylometaphyseal dysplasia (SMD) with metaphyseal fragmentation similar to that noted with abuse, and termed this condition SMD, Sutcliffe/corner fracture type (MIM 184255) (3–5). Patients with this disorder are short, with progressive coxa vara. The condition is genetically transmitted, with either autosomal or X-linked dominant inheritance. Although the radiographic features are strikingly similar to those in child abuse, the long bones are short and dysplastic and the spine is abnormal (Fig. 7.1). With weightbearing, remodeling, and evolution of the dysplastic features, conspicuous medial metaphyseal fragments may be associated with tibia vara (Fig. 7.2).
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- Information
- Diagnostic Imaging of Child Abuse , pp. 217 - 239Publisher: Cambridge University PressPrint publication year: 2015
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