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 Boneillustrates 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
Suspicion, Substantiation, or Exclusion of Inflicted Trauma
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
Radiological Mimickers of Physical Child Abuse
Menkes Disease (Kinky-Hair Syndrome)
Rubella (German Measles)
Fetal Cytomegalovirus Infection
Little Leaguer’s Shoulder
Fractures and Bowing
Perinatal fractures/birth injuries
Handling or "nursing" fractures
Osteogenesis Imperfecta (OI)
Temporary Brittle Bone Disease (TBBD)
Other Causes of Bowing Deformity
Congenital Indifference to Pain (Hereditary Sensory and Autonomic Neuropathy)
Factitious Splitting of the Femoral Head
Supernumerary Ossification Centers
The "Toddler’s Fracture"
Supracondylar Fracture of the Humerus
Little Leaguer’s Elbow
Dislocations—Nontraumatic, Noninfectious, Nonabusive
Periosteal New Bone Formation
Infantile Cortical Hyperostosis (Caffey Disease)
Vitamin A Intoxication
Normal Physiological Periostitis of the Newborn
Coronal Cleft Vertebra
Vertical or Sagittal Cleft
Physiological Sclerosis of the Newborn
Abnormal Fetal Packing
Ping-Pong Ball Fractures
Dermatological Signs of Physical Abuse
Abrasions and Lacerations
Burns by Hot Liquids
Cultural Remedies, Folk Medicine
Caida de la Mollera
Dermatological Mimics of Physical Abuse
Mimics of Bruises
Fixed Drug Eruption
Lichen Sclerosis et Atrophicus
Mimics of Other Pattern Injuries
Staphylococcal Scalded Skin Syndrome (SSSS) Multiforme
Linear IgA Dermatitis
Pityriasis Rubra Pilaris
Staphylococcal Scalded Skin Syndrome
Epidermolysis Bullosa (Blistering Diaper Dermatitis)
Junctional Epidermolysis Bullosa
Toxic Epidermal Necrolysis (Steven Johnson Syndrome)
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.