Traumatic sternal segmental dislocation/fracture may be overlooked on routine skeletal radiography: A lesson from a case of child abuse in infancy

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  • Fujii Akane
    Department of Radiology, Keio University Hospital
  • Tsujioka Yuko
    Department of Radiology, Tokyo Metropolitan Children’s Medical Center
  • Kono Tatsuo
    Department of Radiology, Tokyo Metropolitan Children’s Medical Center
  • Enokizono Mikako
    Department of Radiology, Tokyo Metropolitan Children’s Medical Center
  • Makidono Akari
    Department of Radiology, Tokyo Metropolitan Children’s Medical Center
  • Jinzaki Masahiro
    Department of Radiology, Keio University Hospital

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  • 全身骨単純X線写真のみでは見逃しうる胸骨分節脱臼／骨折：虐待症例における教訓

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<p>Sternal fractures are considered among the most specific signs of child abuse, along with the classical metaphyseal lesions of the long tubular bones and rib fractures, but are less frequently reported in the literature. Most sternal fractures in infants and young children show manubriosternal segmental dislocation/fracture between the manubrium and the body of the sternum. Skeletal survey may not adequately depict sternal lesions due to overlap with the upper extremities or inappropriate radiographic coverage. Lateral images of the spine with the upper limbs elevated are useful for clear sternal visualization, or lateral target imaging of the sternum can be added. Chest Computed Tomography (CT) is excellent in detecting fractures in both the acute and chronic phases. Considering the serious consequences of missing signs of possible abuse, we consider that aggressive use of chest CT is justified in cases where abuse is clinically suspected but not confirmed from radiographs. The 2021 guidelines from the Japan Radiological Society Imaging weakly recommend using chest CT with appropriate dose settings to detect rib fractures in situations of suspected abuse.</p>

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