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Normal spinous process metaphyseal-equivalent lucency simulating infant abuse fractures
Alan E Oestreich1, Christopher G Anton
1Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA, alan.oestreich@cchmc.org.
Insights
A normal radiographic finding in infant thoracolumbar spinous processes can mimic child abuse. This lucency, appearing after the first week of life, is a common developmental variation, not a fracture.
Area of Science:
- Pediatric Radiology
- Skeletal Development
- Forensic Imaging
Background:
- Radiographic interpretation in infants requires distinguishing normal developmental variations from traumatic injuries.
- Child abuse evaluations necessitate careful assessment of skeletal findings to avoid misdiagnosis.
Observation:
- A specific lucency paralleling the posterior margin of ossified spinous processes in young infants is described.
- This finding is observed in the posterior thoracolumbar region after the first week of life.
Findings:
- The observed lucency is analogous to metaphyseal lucent bands in long bones and the 'bone-in-bone' appearance in vertebral bodies.
- Serial imaging of an index case at 3 and 5 weeks of age showed no signs of fracture, such as periosteal reaction or endosteal callus.
Implications:
- Accurate identification of this normal finding can prevent misdiagnosis of child abuse trauma.
- Radiologists and clinicians should be aware of this common developmental variation in infant spine imaging.
Abstract:
We report a normal radiographic finding that may be mistaken for child abuse trauma in the posterior thoracolumbar spinous processes of young infants after the first week of life. A lucency paralleling the posterior margin of the ossified spinous process is equivalent to the metaphyseal lucent bands seen normally after about a week of the child's age at the ends of long tubular bones. A similar lucency is seen just under the growth plate of vertebral bodies at that early age, giving the bone-in-bone appearance. Our index case was imaged at 3 weeks and then at 5 weeks of age, with no evidence of periosteal reaction or endosteal callus on that follow-up study, confirming the lack of fractures.
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