Growth recovery lines: a specific indicator of child abuse and neglect?

BACKGROUND: Growth recovery lines are radiodense lines in long bones reported to be indicators of stress. OBJECTIVE: The purpose of this study was to understand the distribution, quantity and associations of growth recovery lines in children ages 0-24 months with high and low risk for child maltreatment. MATERIALS AND METHODS: We conducted a retrospective cohort study of children ages 0-24 months who had skeletal surveys and an assessment for maltreatment. Growth recovery lines, fractures and osteopenia were assessed independently by two pediatric radiologists blinded to the abuse likelihood. RESULTS: Of the 135 children in this study, 58 were in the low-risk group, 26 were in the neglect group, and 51 were in the physical abuse group. Children in the neglected and physically abused groups had 1.73 times (95% confidence interval [CI] of 1.16, 2.59), P=0.007) and 1.84 times (95% CI 1.28, 2.63, P<0.001) more growth recovery lines than the low-risk group, respectively. Growth recovery lines occurred at an earlier age in the neglect group (age interaction P=0.03) and abuse group (age interaction P=0.01) compared to the low-risk group. The specificity for maltreatment in children with at least 10 growth recovery lines in the long bones was greater than 84%, while sensitivity was less than 35%. The most common locations for growth recovery lines were distal radius, proximal tibia and distal tibia. CONCLUSION: In the absence of a known major stressor, physical abuse and neglect should be considered in children younger than 24 months with at least 10 growth recovery lines.

Spontaneus Suburothelial Hemorrhage Associated With Forniceal Rupture and Retroperitoneal Hemorrhage.

Spontaneous suburothelial hemorrhage is a rare process of unclear pathologic etiology, although it has been associated with bleeding diathesis and anticoagulation. The most common clinical presentation is acute onset flank pain and macroscopic hematuria. On imaging, there is a mural thickening of the renal pelvis and upper ureters leading to luminal narrowing. Despite luminal narrowing, hydronephrosis has only rarely been reported in the association. The imaging finding of mural thickening has led to the misdiagnosis as malignancy, resulting in unnecessary nephrectomy. Suburothelial hemorrhage can be unilateral or bilateral, although the majority of reported cases are unilateral. We present a case of a patient with bilateral spontaneous suburothelial hemorrhage with forniceal rupture and spontaneous retroperitoneal hemorrhage, a unique triad compared to prior cases presented in the literature.

The Case of the Rare Malformation and Rare Variant: An Infant with a Self-Embolized Torcular Dural Sinus Malformation and a Concomitant Prothrombin Variant.

Torcular dural sinus malformations (tDSMs) can occur in the brain during prenatal development. These rare vascular malformations occur in less than 1% of the population but can lead to a poor prognosis secondary to congestive heart failure and hydrocephalus. Many tDSM cases require surgical embolization or coiling to return normal cerebral blood flow and prevent mortality and morbidity. We describe the first case of spontaneous self-embolization of a large torcular dural sinus malformation, possibly due to hypercoagulability from a comorbid prothrombin gene variant. Despite a grim prognosis at birth, the child is alive and thriving at age 3, with only mild speech delay.

Slipped Capital Femoral Epiphysis as a Presentation of Underlying Metabolic Disorders: Pseudohypoparathyroidism and Juvenile Hypothyroidism.

Slipped capital femoral epiphysis (SCFE) is an abnormality of the proximal femoral physis typically occurring in adolescents and most commonly associated with obesity, although its exact etiology is unknown. In addition to obesity, other associations and predisposing factors proposed in the literature include trauma, vascular injury or compromise, and immunologic, genetic, and metabolic conditions. While not common, metabolic conditions are known to predispose to SCFE and it is essential for radiologists to recognize SCFE as a possible initial presentation of an underlying metabolic disorder. Understanding imaging findings and identification of atypical presentations of SCFE by radiologists can assist clinicians in guiding workup and lead to expedited treatment to prevent worsening outcomes associated with developmental delay.