Ischial apophyseal fracture in an abused infant
Sarah D Bixby1, Celeste R Wilson, Ignasi Barber
1Department of Radiology, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, 02115, USA, sarah.bixby@childrens.harvard.edu.
Insights
A previously healthy infant presented with leg pain and fractures. Imaging revealed an unusual ischial fracture, prompting further investigation beyond suspected child abuse.
Area of Science:
- Pediatric Radiology
- Skeletal Imaging
- Child Abuse Evaluation
Background:
- Child abuse is a significant concern in infants presenting with fractures.
- Femur fractures in infants often warrant a thorough skeletal survey to rule out abuse.
- Langerhans cell histiocytosis can mimic traumatic bone lesions.
Observation:
- A 4-month-old presented with leg pain and swelling, with radiographs showing a comminuted left femur fracture.
- Skeletal survey revealed vertebral compression deformities, raising suspicion for abuse.
- 18F-NaF PET scintigraphy and MRI confirmed an ischial apophyseal fracture.
Findings:
- Pelvic fractures, especially ischial fractures, are rare in cases of suspected child abuse.
- Multimodality imaging is crucial for diagnosing complex fractures in infants.
- The findings highlight the importance of considering underlying conditions in fracture evaluation.
Implications:
- This case underscores the diagnostic challenges in differentiating abuse from underlying pathology in infants.
- It emphasizes the role of advanced imaging techniques in identifying subtle or rare fractures.
- Accurate diagnosis is critical for appropriate management and intervention in pediatric skeletal injuries.
Abstract:
We report a previously healthy 4-month-old who presented to the hospital with leg pain and swelling and no history of trauma. Radiographs demonstrated a comminuted left femur fracture. Given the concern for child abuse, skeletal survey was performed and revealed four vertebral compression deformities. Although abuse was suspected, the possibility of a lytic lesion associated with the femur fracture and multiple spinal abnormalities raised the possibility of an underlying process such as Langerhans cell histiocytosis. Subsequently 18F-NaF positron emission tomographic (PET) scintigraphy revealed increased tracer activity in the ischium, and MRI confirmed an ischial apophyseal fracture. Pelvic fractures, particularly ischial fractures, are extremely rare in the setting of child abuse. This case report describes the multimodality imaging findings of an ischial fracture in an abused infant.
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