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Background
Children represent an especially vulnerable population, requiring special attention and protection. Diagnosing victims of child abuse is crucial, but incorrect accusations are damaging and disruptive to caregivers of suspected victims. Because of this, recognizing child abuse and mimics of abuse is essential. This exhibit aims to familiarize the radiologist with findings indicative of abuse, describe clinical and imaging approaches, including best practices for imaging, and discuss various processes potentially mistaken for child abuse, including presentation, pathophysiology, and imaging features to aid in differentiation.

Educational Goals / Teaching Points
Introduction to child abuse emphasizing importance of accurate identification. Clinical and imaging approaches, including best practices for imaging. Various pathologies potentially mistaken for child abuse, including presentation, pathophysiology, and imaging features to aid in differentiation.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
This exhibit highlights pathological processes that may be misleading for abuse and their associated imaging findings. Examples include skull fractures due to accidental injury, congenital and developmental variants (e.g., variant sutures, Wormian bones), or birth trauma; intracranial or retinal hemorrhage due to accidental injury, congenital or developmental variants (e.g., benign extracerebral collections, cerebral vascular malformations), birth trauma, hematologic diseases and coagulation disorders (e.g., acute leukemia, hemophilia, sickle cell disease), infections and postinfectious conditions (e.g., congenital cytomegalovirus, subdural empyema), hypoxic and ischemic disorders (e.g., hypoxic ischemic encephalopathy, intracranial venous thrombosis), metabolic disorders (e.g., galactosemia, Menke’s disease), or other genetic disorders (e.g., Prader-Willi); fractures due to birth trauma, primary bone diseases (e.g., bone cysts, Langerhan’s cell histiocytosis), or connective tissue disorders and skeletal dysplasias (e.g., osteogenesis imperfecta); periosteal reaction due to physiologic periostitis, vitamin deficiencies (e.g., vitamin C or D deficiency), or metabolic disorders (e.g., Menkes disease).

Conclusion
There are many potential mimics of child abuse, some of which are rare, but knowledge of potential differential diagnoses can help radiologists recognize and contextualize discriminating findings in unclear or unusual cases. It is also important to be aware of which diagnoses are more frequently used by courtroom defense experts, why they are used, and which diagnoses are widely disputed.