A one month old infant misdiagnosed with parietal bone fracture and child abuse (922.3)

Abstract

INTRODUCTION. A month‐old female infant was brought to the emergency room because she would not take in fluids. Her mother indicated the infant had a birth history of a traumatic brain injury stemming from a difficult instrumental delivery. A nurse assigned to care for the infant observed what appeared to be blood on the right ear. She immediately alerted the pediatrician on duty of a possible case of child abuse. The pediatrician concurred and ordered an anterior‐posterior chest radiograph and anterior posterior and lateral skull radiographs. RESULTS. The chest radiograph was interpreted by the hospital radiologist as being positive for fractures of the ribs and the skull radiographs as being positive for bilateral parietal bone fractures without soft tissue swelling. Three‐dimensional computerized axial tomography was then performed and interpreted as positive for bilateral parietal bone fractures. Although the infant was not in acute distress, she was hospitalized with the suspected diagnosis of child abuse. An outside radiologist was consulted finding no evidence of fractures and/or swelling over the sites dictated by the hospital radiologist. The outside radiologist found an anomalous parietal bone suture misinterpreted as the parietal bone fracture. CONCLUSIONS. The purpose of this presentation is not to review the division of the parietal bone but to inform physicians and health professionals that anomalous parietal bone sutures are rare and often misdiagnosed as fractures.