Nonaccidental trauma | Figure 1

CincyKidsRad

Cincinnati Children's Radiology

Nonaccidental trauma

AP (image 1) and lateral (image 2) radiographs of the right femur in a one-year-old shows extensive periosteal new bone (arrow) and anterior displacement of the distal femoral epiphysis (arrowhead). The extensive new bone formation provides evidence that the fracture is at least 10-14 days of age. In an infant with delayed presentation of a long bone injury and no explanatory history, nonaccidental trauma should be suspected and a skeletal survey performed to identify other findings potentially related to abuse.

Similar cases

AP (image 1 and 2) and lateral (image 3) radiographs of the femur reveal a small lucent lesion (arrow) within central periosteal new bone formation. In what manner would you anticipate a patient with this finding to present?

AP (image 1) and oblique (image 2) views of the foot shows subtle periosteal new bone (arrow) formation along the medial aspect of the third metatarsal. The subtle periosteal new bone formation is typical of a stress fracture of the metatarsal. Second AP radiograph taken several weeks later (image 3) shows considerable periosteal new bone formation (arrow) at the fracture site. Stress fractures occur from overuse and repetitive injury such as in runners. Stress fractures most commonly occur in the second and third metatarsals of the foot as these bones absorb the greatest impact during running. Other comment locations of stress fractures include the fibula, calcaneus, talus, navicular, and cuboid.

Axial T2-weighted MRI (image 1), contrast-enhanced CT in soft tissue (image 2) and bone windows (image 3), and ultrasound (image 4) show an ectomesenchymoma (arrow) of the mandible with associated bone destruction (arrowhead) and new bone formation. Ectomesenchymomas are rapidly growing tumors that typically occur in children. They are most common within the head and neck, though they can also arise in the abdomen, pelvis, and extremities.

Axial (image 1) and coronal (image 2) CT centered at the petrous bone shows a destructive soft tissue lesion (arrow) at the base of the skull involving the anterior aspect of the left petrous apex. Axial (image 3) and coronal (image 4) T1-weighted postcontrast MRI, and axial FLAIR (image 5) highlight the soft tissue mass (arrow) with extension to the internal auditory canal (arrowhead). Extension into the multiple neural foramina and the cavernous sinus was also present (not shown). At biopsy, this was confirmed to represent a rhabdomyosarcoma. Rhabdomyosarcoma is the most common soft tissue sarcoma in children. The head and neck is the most commonly affected site, accounting for 40% of patients. Patient with skull base rhabdomyosarcoma often present with headaches and cranial nerve involvement. Historically, prognosis at this location has been dismal. However, it has improved recently with new or surgical techniques.