Purpose or Case Report: Because of the consequences of missed non-accidental trauma, it is essential for pediatric radiologists to have a high index of suspicion for injuries related to non-accidental trauma. Certain patterns of fracture raise suspicion for non-accidental trauma and are often considered pathognomonic. We present several cases of fractures that are typically considered pathognomonic for non-accidental trauma that had other non-abuse etiologies. These cases include classic metaphyseal lesions, subdural hematomas and long bone fracture in non-ambulatory patients among others. While there may be non-abuse etiologies of fractures that are classically considered pathognomonic for child abuse, the illustrative cases demonstrate the severe magnitude of injury necessary to produce these findings. This is why it is essential to evaluate the patient history and identify if the resulting injuries are consistent with the history.
Methods & Materials: 1. Review fractures classically considered pathognomonic in non-accidental trauma.
2. Illustrate examples of fractures classically considered pathognomonic for abuse with an etiology other than non-accidental trauma.
3. Discuss the importance of critically evaluating history in cases of pathognomonic fractures.
Results: We review multiple cases of fractures that are classically considered pathognomonic for non-accidental trauma with varying etiologies other than non-accidental trauma.
Conclusions: Fractures that are classically pathognomonic for nonaccidental trauma are important to recognize. Although rare, it is equally important to consider other possible causes to avoid mislabeling fractures as related to nonaccidental trauma. Critical evaluation of patient history is important because the appropriate diagnosis significantly impacts management.