Child Abuse and its Mimics in Skin and Bone: 1st Edition (Hardback) book cover

Child Abuse and its Mimics in Skin and Bone

1st Edition

By B. G. Brogdon, Tor Shwayder, Jamie Elifritz

CRC Press

216 pages | 313 Color Illus. | 313 B/W Illus.

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Of all children reported to child protective services for suspected maltreatment in any form, the percentage of substantiated cases of actual physical abuse is quite small. There are a number of dermatological or radiologically demonstrable musculoskeletal lesions that have been, or could be mistaken for, intentional physical abuse by the inexperienced or untrained observer.

Child Abuse and Its Mimics in Skin and Bone illustrates the classic manifestations of physical abuse by dermatological and radiological examination as a standard against which the mimickers of physical abuse can be compared. Beginning with a historical perspective on child abuse, the book explores manifestations of superficial and musculoskeletal trauma in children. It examines conditions often mistaken for child abuse, ranging from rubella to leukemia and bowing deformities to vitamin A intoxication, as well as a plethora of dermatological conditions that can mimic signs of physical abuse.

Designed for a broad spectrum of individuals who may first encounter a possibly abused child, the book presents hundreds of photos—many in color—and examples collected by the authors over their years of experience in their respective fields. Where appropriate, the authors provide pertinent historical, physical, and laboratory information in support of the diagnosis.

With the combined insight of top experts in forensic radiology and dermatology, this volume enables clinicians and others confronted with cases involving these conditions to avoid a rush to judgment that could wreak havoc in a family and quite possibly delay needed treatment for an actual medical condition.

Table of Contents

The Concept of Child Abuse in Historical Perspective

Trauma—Inflicted or Accidental?

Incidence of Inflicted Trauma

Risk Factors

Suspicion, Substantiation, or Exclusion of Inflicted Trauma

Dermatologic Survey

Radiologic Survey

Musculoskeletal Trauma in Infants and Children: Accidental or Inflicted?

Part 1: Introduction

Injuries to the Bones and Joints in Children: Incidence

The Dilemma of Discrimination

Context Is Critical

Part 2: Radiological Findings in Nonaccidental Trauma


Fractures of the Appendicular Skeleton

Fractures of the Axial Skeleton

The Skull

Radiological Mimickers of Physical Child Abuse

Metaphyseal Lesions



Menkes Disease (Kinky-Hair Syndrome)

Congenital Syphilis

Intrauterine Infection

Rubella (German Measles)

Fetal Cytomegalovirus Infection

Metaphyseal Chondrodysplasias

Schmid Type



Little Leaguer’s Shoulder


Stippled Epiphyses

Fractures and Bowing

Perinatal fractures/birth injuries

Handling or "nursing" fractures

Osteogenesis Imperfecta (OI)

Temporary Brittle Bone Disease (TBBD)

Bowing Deformities


Other Causes of Bowing Deformity

Congenital Indifference to Pain (Hereditary Sensory and Autonomic Neuropathy)

False Fractures

Factitious Splitting of the Femoral Head

Supernumerary Ossification Centers

Panner’s Disease

Normal Fractures

The "Toddler’s Fracture"

Supracondylar Fracture of the Humerus

Little Leaguer’s Elbow

Dislocations—Nontraumatic, Noninfectious, Nonabusive


Larsen’s Syndrome

Periosteal New Bone Formation



Congenital Syphilis



Infantile Cortical Hyperostosis (Caffey Disease)

Prostaglandin Therapy

Vitamin A Intoxication

Familial Hypophosphatemia

Normal Physiological Periostitis of the Newborn

The Spine

Coronal Cleft Vertebra

Vertical or Sagittal Cleft


Spina Bifida

Physiological Sclerosis of the Newborn

Hurler Syndrome

Stippled Epiphyses


Vertebra Plana

The Skull

Increased Pressure?


Wormian Bones


Leptomeningeal Cyst

Abnormal Fetal Packing

Ping-Pong Ball Fractures

Dermatological Signs of Physical Abuse


Abrasions and Lacerations

Bite Marks

Hair Pulling


Burns by Hot Liquids

Contact burns

Neither/Nor Lesions

Cultural Remedies, Folk Medicine




Caida de la Mollera

Dermatological Mimics of Physical Abuse

Mimics of Bruises



Lichen Aureus

Erythema Nodosum


Fixed Drug Eruption

Pityriasis Rosea

Pyoderma Gangrenosum

Lichen Sclerosis et Atrophicus

Mimics of Other Pattern Injuries

Amniotic Bands


Staphylococcal Scalded Skin Syndrome (SSSS) Multiforme

Koebner Phenomenon


Lupus Erythematosis

Schamberg’s Purpura

Pityriasis Lichenoides

Linear IgA Dermatitis

Bullous Mastocytosis

Pityriasis Rubra


Pityriasis Rubra Pilaris


Seborrheic Dermatitis

Staphylococcal Scalded Skin Syndrome

Epidermolysis Bullosa (Blistering Diaper Dermatitis)

Junctional Epidermolysis Bullosa

Toxic Epidermal Necrolysis (Steven Johnson Syndrome)

About the Authors

In his 60 years in radiology, B.G. Brogdon, MD, FACR, has pursued special interests in pediatric, musculoskeletal, and forensic radiology. A graduate of the University of Arkansas and its College of Medicine, his academic career has included faculty appointments at the University of Florida; radiologist in charge, Division of Diagnostic Radiology, Johns Hopkins; chair of the Department of Radiology at the University of New Mexico; and now as university distinguished professor emeritus and former chair at the University of South Alabama. He is the author, coauthor, or editor of some 360 publications, including the classic Brogdon’s Forensic Radiology, now in its second edition, and the prize-winning Atlas of Abuse, Torture Terrorism and Inflicted Trauma (CRC Press).

Tor Shwayder, MD, FAAP, FAAD, received a BA from Harvard University and attended the University of Michigan for medical school and pediatric residency. He was in pediatric practice for a short while before attending the University of Rochester Strong Memorial Hospital for dermatology training. He has been Director of Pediatric Dermatology at Henry Ford Hospital since 1987.

Jamie Elifritz, MD, DABR, is a graduate of the Wright State School of Medicine in Dayton, Ohio. She became immersed in forensic radiology as a radiology resident under the direction of Dr. Brogdon at the University of South Alabama in Mobile. She completed a musculoskeletal and forensic radiology fellowship at the University of New Mexico in Albuquerque, where she now occupies the position of assistant professor with a dual appointment in the departments of Radiology and Pathology. She is a member of the Center for Forensic Imaging at the Office of the Medical Investigator in Albuquerque, New Mexico.

Subject Categories

BISAC Subject Codes/Headings:
LAW / Forensic Science
MEDICAL / Radiology & Nuclear Medicine