PMC5504945_01
Bone scan: multiple increased radioactive foci throughout the whole body (arrows) were accidentally found. There was a strong probability of child abuse.
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fig1
Tc-99m MDP was performed for an evaluation of suspicious malunion fracture, bone infection, or preexisting medical conditions because metabolic disorders and bone diseases may make a child's bones more vulnerable to fracture. Multiple increased radioactive foci throughout the whole body (Figure 1) were unexpectedly found. There was a strong probability of child abuse.
X-ray: a series of plain film radiographs demonstrated calvarial fracture lines at left temporoparietal region, bony anomaly of the spine, multiple old fractures with callus formation involving posterior aspect of left 10, 11th ribs, right proximal humerus, bilateral proximal femurs, and metaphyses of tibias (arrows). Adjacent soft tissue swelling is evident. The above findings were consistent with child abuse.
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fig2
A series of plain film radiographs demonstrated calvarial fracture lines at left temporoparietal region, bony anomaly of the spine, multiple old fractures with callus formation involving posterior aspect of left 10th, 11th ribs, right proximal humerus, bilateral proximal femurs, and metaphyses of tibias (Figure 2).
MRI of both lower legs: the T2-weighted coronal images show metaphyseal fractures involving distal left femur and proximal bilateral tibias with extensive periosteal hemorrhage or edema, favored child abuse.
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Radiographic skeletal survey and radionuclide images are complementary procedures for diagnosis and documenting this type of injury (Figure 3).
X-ray: the previous multiple bony fractures with callus formation are not prominent on the following plain film radiograph 6 months later.
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This case was reported and social workers dealt with this event. The previous multiple bony fractures with callus formation were not prominent on the following plain film radiograph, which was taken 6 months later (Figure 4).