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Accessory Parietal Suture versus Parietal bone fracture in a case of suspected Non-accidental injury- A real life Diagnostic dilemma
Poster Title: Accessory Parietal Suture versus Parietal bone fracture in a case of suspected Non-accidental injury- A real life Diagnostic dilemma
Submitted on 27 Sep 2019
Author(s): Dr ZY Nizar, Dr VK Baskaradoss
Affiliations: Bedford Hospital
This poster was presented at BIR Annual Congress 2019
Poster Views: 672
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Poster Information
Abstract: Radiological differentiation between sutures and fractures is difficult in neonatal population due to the presence of multiple synchondroses and rare accessory sutures. Plain film evaluation has been replaced by Spiral and Multidetector CT over the last few decades due to the diagnostic confidence offered in such an enigma.
We herein report an unusual case of a 14-week old infant presenting with a suspicion of Non-accidental head injury and a Parietal bone defect but no clinical or radiological features suggestive of trauma.
We would like to highlight the factors pertinent to radiological distinction of both which is crucial especially in the current context of suspected Non-accidental head injury since delayed diagnosis worsens prognosis. Knowledge of the radiological appearance of accessory sutures and its differences from fractures is paramount in identification of children suspected with Non-accidental injury as the management of both are divergent and has many litigious implications. On the contrary it reduces the morbidity and mortality associated with false negative interpretation of fractures as sutures in the context of accidental or non-accidental head injury
Summary: This poster is a case report of a 14 week old infant who was suspected to have a skull fracture following a high suspicion of Non-accidental head injury from violence or parent abuse which turned out to be an accessory skull suture. This clinical case had much medico-legal significance.References: 1.Kemp AM, Butler A, Morris S, Mann M, et al. Which radiological investigations should be performed to identify fractures in suspected child abuse? Clin Radiol. 2006;61(9):723–736. doi: 10.1016/j.crad.2006.03.017.
2. Kleinman PK, Spevak MR. Soft tissue swelling and acute skull fractures. J Pediatr. 1992;121(5):737–739. doi: 10.1016/ S0022-3476(05)81904-3
3. Nakahara K, Miyasaka Y, Takagi H, Kan S, Fujii K. Unusual accessory cranial sutures in pediatric head trauma—case report.
4. Weir P, Suttner NJ, Flynn P, McAuley D. Normal skull suture variant mimicking intentional injury. BMJ. 2006;332(7548):1020–1021 5. Meservy CJ, Towbin R, McLaurin RL, Myers PA, Ball W. Radiographic characteristics of skull fractures resulting from child abuse.
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