Forensic Radiology to the Rescue: Prenatal imaging used to solve a case of a newborn with suspected non-accidental trauma

Abstract

The allegation of child abuse, or non-accidental trauma, is very serious and can have a devastating impact on children and their families. However, the lack of recognition of injuries resulting from abusive incidents can be equally detrimental. When a child presents to the emergency facility with a suspicious injury it is of the utmost importance that a well-documented medical history be obtained.

We present a case of a 3-day old infant sent to the pediatric ER after the pediatrician noted bruising over the right shoulder and clavicle. A subsequent skeletal survey performed demonstrated a mildly depressed skull fracture and an overriding displaced right clavicular fracture raising a concern of non-accidental trauma (NAT). Upon further review of the patient's history, it was noted that the mother was involved in a high- speed motor vehicle collision on the day of delivery. Review of the mother's body trauma computed tomography (CT) scan revealed that the injuries were, in fact, sustained in utero and obviating the need for further NAT work up and investigation. This case demonstrates forensic use of radiologic images to establish a diagnosis of an accidental trauma.