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Intraosseous vascular access defect: fracture mimic in the skeletal survey for child abuse
1Department of Radiology, University of Iowa Hospitals and Clinics, Iowa City 52242, USA. mary-harty@uiowa.edu
Insights
Intraosseous needles used for vascular access in infants can create bone defects. These lesions in the proximal tibia should not be misdiagnosed as child abuse injuries.
Area of Science:
- Pediatric Radiology
- Emergency Medicine
- Child Abuse Diagnosis
Background:
- Infants presenting with injuries suggestive of child abuse undergo skeletal surveys.
- Radiographic findings can be misinterpreted, leading to potential misdiagnosis.
Observation:
- Two infants showed cortical bone defects in proximal tibiae on skeletal surveys.
- These defects were initially suspected as signs of child abuse, specifically healing fractures.
Findings:
- Further investigation revealed intraosseous (IO) vascular access needles were placed at the sites of these bone defects.
- The cortical lesions corresponded directly to the IO needle insertion sites.
Implications:
- Radiologists and clinicians must consider IO needle placement when evaluating proximal tibial cortical defects in infants.
- This differentiation is crucial to avoid misdiagnosing non-accidental trauma and ensure appropriate patient care.
Abstract:
Two infants were transferred to the emergency department for injuries suggestive of child abuse. Skeletal surveys showed cortical bone defects in the proximal tibiae that were initially interpreted as healing fractures. Further investigation, however, revealed that intraosseous (IO) vascular access needles had been placed at these sites in both infants. In the appropriate clinical setting, a cortical lesion in the proximal tibia corresponding to the site of IO needle insertion should not be mistaken for a radiographic sign of child abuse.