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 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 TraumaIntroduction Fractures of the Appendicular Skeleton Fractures of the Axial Skeleton The Skull Radiological Mimickers of Physical Child Abuse Metaphyseal Lesions Scurvy Rickets Menkes Disease (Kinky-Hair Syndrome) Congenital Syphilis Intrauterine Infection Rubella (German Measles) Fetal Cytomegalovirus Infection Metaphyseal Chondrodysplasias Schmid Type Leukemia Meningococcemia Little Leaguer’s Shoulder Hypophosphatasia Stippled Epiphyses Fractures and Bowing Perinatal fractures/birth injuries Handling or "nursing" fractures Osteogenesis Imperfecta (OI) Temporary Brittle Bone Disease (TBBD) Bowing Deformities Neurofibromatosis 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 Arthrogryposis Larsen’s Syndrome Periosteal New Bone Formation Scurvy Rickets Congenital Syphilis Leukemia Osteomyelitis 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 Hemivertebrae Spina Bifida Physiological Sclerosis of the Newborn Hurler Syndrome Stippled Epiphyses Infarction Vertebra Plana The Skull Increased Pressure? Fractures Wormian Bones Cephalohematoma Leptomeningeal Cyst Abnormal Fetal Packing Ping-Pong Ball Fractures Dermatological Signs of Physical Abuse Bruises Abrasions and Lacerations Bite Marks Hair Pulling Burns Burns by Hot Liquids Contact burns Neither/Nor Lesions Cultural Remedies, Folk Medicine Coining Cupping Moxibustion Caida de la Mollera Dermatological Mimics of Physical Abuse Mimics of Bruises Hyperpigmentation Purpura Lichen Aureus Erythema Nodosum Morphea Fixed Drug Eruption Pityriasis Rosea Pyoderma Gangrenosum Lichen Sclerosis et Atrophicus Mimics of Other Pattern Injuries Amniotic Bands Striae Staphylococcal Scalded Skin Syndrome (SSSS) Multiforme Koebner Phenomenon Burns Lupus Erythematosis Schamberg’s Purpura Pityriasis Lichenoides Linear IgA Dermatitis Bullous Mastocytosis Pityriasis Rubra Morphea Pityriasis Rubra Pilaris Ringworm/Tinea Seborrheic Dermatitis 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.