Child Abuse and its Mimics in Skin and Bone

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.

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. Musculoskeletal Trauma in Infants and Children: Accidental or Inflicted? Part 1: Introduction. Part 2: Radiological Findings in Nonaccidental Trauma. Radiological Mimickers of Physical Child Abuse. Metaphyseal Lesions. Fractures and Bowing. Bowing Deformities. Congenital Indifference to Pain (Hereditary Sensory in Autonomic Neuropathy). False Fractures. Normal Fractures. Dislocations—Nontraumatic, Noninfectious, Nonabusive. Periosteal New Bone Formation. The Spine. The Skull. Dermatological Signs of Physical Abuse. Bruises. Abrasions and Lacerations. Bite Marks. Hair Pulling. Burns. Neither/Nor Lesions. Cultural Remedies, Folk Medicine. Dermatological Mimics of Physical Abuse. Mimics of Bruises. Mimics of Other Pattern Injuries. Burns.

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.