Costochondral junction variations in children younger than 2 years

Area of Science:

• Pediatric radiology
• Skeletal imaging
• Child abuse diagnostics

Background:

• Costochondral junction fractures are often indicative of child abuse.
• These fractures typically result in a deformed costochondral junction after healing.

Purpose of the Study:

• To determine the types, locations, and frequency of costochondral junction variations.
• To assess if these variations can be mistaken for fractures in children.

Main Methods:

• Retrospective analysis of 117 children under 2 years old who underwent CT scans.
• Two pediatric radiologists independently reviewed scans for costochondral junction variations.
• Disagreements were resolved by a third radiologist; statistical analysis was performed.

Main Results:

• Costochondral junction variations were found in 16.2% of the study group (19 out of 117 children).
• These variations, primarily spurs on ribs 2-8, were more common in younger children and with thinner CT slice thickness.
• Inter-radiologist agreement was fair at the patient level (kappa=0.29) and poor at the rib level.

Conclusions:

• Costochondral junction variations occur in 16.2% of children under 2 years.
• Some variations may present similarly to healing costochondral junction fractures.
• Limited radiologist agreement suggests potential for misinterpretation.