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Child Abuse, Rib Fractures
Michael R. Aquino, MD, MHSc
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • Nonaccidental trauma or injury (NAT, NAI), child abuse & neglect
          • Synonyms

            • Battered child syndrome, Kempe-Silverman syndrome
          • Definitions

            • Child abuse: Any act or failure to act by parent/caretaker that causes harm or imminent risk of harm to child

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • MR Findings

                  • Ultrasonographic Findings

                    • Nuclear Medicine Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Gross Pathologic & Surgical Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Image Interpretation Pearls

                                        • Reporting Tips

                                          Selected References

                                          1. Barber I et al: The yield of high-detail radiographic skeletal surveys in suspected infant abuse. Pediatr Radiol. 45(1):69-80, 2015
                                          2. Kleinman, Paul K. Diagnostic Imaging of Child Abuse. Cambridge University Press, 2015.
                                          3. Darling SE et al: Frequency of intrathoracic injuries in children younger than 3 years with rib fractures. Pediatr Radiol. 44(10):1230-6, 2014
                                          4. U.S. Department of Health & Human Services, Administration for Children & Families, Administration on Children, Youth & Families, Children’s Bureau. (2016). Child maltreatment 2014.
                                          5. Duffy SO et al: Use of skeletal surveys to evaluate for physical abuse: analysis of 703 consecutive skeletal surveys. Pediatrics. 127(1):e47-52, 2011
                                          6. Karmazyn B et al: The prevalence of uncommon fractures on skeletal surveys performed to evaluate for suspected abuse in 930 children: should practice guidelines change? AJR Am J Roentgenol. 197(1):W159-63, 2011
                                          7. Drubach LA et al: Skeletal trauma in child abuse: detection with 18F-NaF PET. Radiology. 255(1):173-81, 2010
                                          8. Perez-Rossello JM et al: Whole-body MRI in suspected infant abuse. AJR Am J Roentgenol. 195(3):744-50, 2010
                                          9. Turk F et al: Evaluation by ultrasound of traumatic rib fractures missed by radiography. Emerg Radiol. 17(6):473-7, 2010
                                          10. Kelloff J et al: Acute rib fracture diagnosis in an infant by US: a matter of child protection. Pediatr Radiol. 39(1):70-2, 2009
                                          11. Hansen KK et al: Oblique chest views as a routine part of skeletal surveys performed for possible physical abuse--is this practice worthwhile? Child Abuse Negl. 32(1):155-9, 2008
                                          12. Kemp AM et al: Patterns of skeletal fractures in child abuse: systematic review. BMJ. 337:a1518, 2008
                                          13. Leventhal JM et al: Incidence of fractures attributable to abuse in young hospitalized children: results from analysis of a United States database. Pediatrics. 122(3):599-604, 2008
                                          14. Peters ML et al: The presence of bruising associated with fractures. Arch Pediatr Adolesc Med. 162(9):877-81, 2008
                                          15. Wootton-Gorges SL et al: Comparison of computed tomography and chest radiography in the detection of rib fractures in abused infants. Child Abuse Negl. 32(6):659-63, 2008
                                          16. Kemp AM et al: Which radiological investigations should be performed to identify fractures in suspected child abuse? Clin Radiol. 61(9):723-36, 2006
                                          17. Zimmerman S et al: Utility of follow-up skeletal surveys in suspected child physical abuse evaluations. Child Abuse Negl. 29(10):1075-83, 2005
                                          18. Barsness KA et al: The positive predictive value of rib fractures as an indicator of nonaccidental trauma in children. J Trauma. 54(6):1107-10, 2003
                                          19. Lonergan GJ et al: From the archives of the AFIP. Child abuse: radiologic-pathologic correlation. Radiographics. 23(4):811-45, 2003
                                          20. Mandelstam SA et al: Complementary use of radiological skeletal survey and bone scintigraphy in detection of bony injuries in suspected child abuse. Arch Dis Child. 88(5):387-90; discussion 387-90, 2003
                                          21. Kleinman PK et al: Inflicted skeletal injury: a postmortem radiologic-histopathologic study in 31 infants. AJR Am J Roentgenol. 165(3):647-50, 1995
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Pathology

                                                • Clinical Issues

                                                  TERMINOLOGY

                                                  • Abbreviations

                                                    • Nonaccidental trauma or injury (NAT, NAI), child abuse & neglect
                                                  • Synonyms

                                                    • Battered child syndrome, Kempe-Silverman syndrome
                                                  • Definitions

                                                    • Child abuse: Any act or failure to act by parent/caretaker that causes harm or imminent risk of harm to child

                                                  IMAGING

                                                  • General Features

                                                    • Radiographic Findings

                                                      • CT Findings

                                                        • MR Findings

                                                          • Ultrasonographic Findings

                                                            • Nuclear Medicine Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Gross Pathologic & Surgical Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Image Interpretation Pearls

                                                                                • Reporting Tips

                                                                                  Selected References

                                                                                  1. Barber I et al: The yield of high-detail radiographic skeletal surveys in suspected infant abuse. Pediatr Radiol. 45(1):69-80, 2015
                                                                                  2. Kleinman, Paul K. Diagnostic Imaging of Child Abuse. Cambridge University Press, 2015.
                                                                                  3. Darling SE et al: Frequency of intrathoracic injuries in children younger than 3 years with rib fractures. Pediatr Radiol. 44(10):1230-6, 2014
                                                                                  4. U.S. Department of Health & Human Services, Administration for Children & Families, Administration on Children, Youth & Families, Children’s Bureau. (2016). Child maltreatment 2014.
                                                                                  5. Duffy SO et al: Use of skeletal surveys to evaluate for physical abuse: analysis of 703 consecutive skeletal surveys. Pediatrics. 127(1):e47-52, 2011
                                                                                  6. Karmazyn B et al: The prevalence of uncommon fractures on skeletal surveys performed to evaluate for suspected abuse in 930 children: should practice guidelines change? AJR Am J Roentgenol. 197(1):W159-63, 2011
                                                                                  7. Drubach LA et al: Skeletal trauma in child abuse: detection with 18F-NaF PET. Radiology. 255(1):173-81, 2010
                                                                                  8. Perez-Rossello JM et al: Whole-body MRI in suspected infant abuse. AJR Am J Roentgenol. 195(3):744-50, 2010
                                                                                  9. Turk F et al: Evaluation by ultrasound of traumatic rib fractures missed by radiography. Emerg Radiol. 17(6):473-7, 2010
                                                                                  10. Kelloff J et al: Acute rib fracture diagnosis in an infant by US: a matter of child protection. Pediatr Radiol. 39(1):70-2, 2009
                                                                                  11. Hansen KK et al: Oblique chest views as a routine part of skeletal surveys performed for possible physical abuse--is this practice worthwhile? Child Abuse Negl. 32(1):155-9, 2008
                                                                                  12. Kemp AM et al: Patterns of skeletal fractures in child abuse: systematic review. BMJ. 337:a1518, 2008
                                                                                  13. Leventhal JM et al: Incidence of fractures attributable to abuse in young hospitalized children: results from analysis of a United States database. Pediatrics. 122(3):599-604, 2008
                                                                                  14. Peters ML et al: The presence of bruising associated with fractures. Arch Pediatr Adolesc Med. 162(9):877-81, 2008
                                                                                  15. Wootton-Gorges SL et al: Comparison of computed tomography and chest radiography in the detection of rib fractures in abused infants. Child Abuse Negl. 32(6):659-63, 2008
                                                                                  16. Kemp AM et al: Which radiological investigations should be performed to identify fractures in suspected child abuse? Clin Radiol. 61(9):723-36, 2006
                                                                                  17. Zimmerman S et al: Utility of follow-up skeletal surveys in suspected child physical abuse evaluations. Child Abuse Negl. 29(10):1075-83, 2005
                                                                                  18. Barsness KA et al: The positive predictive value of rib fractures as an indicator of nonaccidental trauma in children. J Trauma. 54(6):1107-10, 2003
                                                                                  19. Lonergan GJ et al: From the archives of the AFIP. Child abuse: radiologic-pathologic correlation. Radiographics. 23(4):811-45, 2003
                                                                                  20. Mandelstam SA et al: Complementary use of radiological skeletal survey and bone scintigraphy in detection of bony injuries in suspected child abuse. Arch Dis Child. 88(5):387-90; discussion 387-90, 2003
                                                                                  21. Kleinman PK et al: Inflicted skeletal injury: a postmortem radiologic-histopathologic study in 31 infants. AJR Am J Roentgenol. 165(3):647-50, 1995