Purpose or Case Report: Skeletal surveys play a pivotal role in the evaluation of children in whom non-accidental injury (NAI) is being considered. Typically, the principles used to interpret skeletal surveys assume that the underlying bones are normal. Complexity is added when this is not true, making the “rules” less reliable. The goal of interpretation shifts to identifying the underlying abnormality and then making an assessment as to whether inflicted injury is part of the picture. There are also clinical and imaging “distractors” that can cause additional challenges in study interpretation. In this educational poster, utilizing cases from our institution, we review the imaging findings of these “confounders” (including metabolic bone disease, genetic disorders, prematurity, metastatic disease) and “distractors” (unexpected pathologies), discuss potential discriminators and pathways to aid in the interpretation of unexpected findings in skeletal surveys.
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