A second radiographic skeletal survey for child abuse triggered by bone scintigraphy found positive after the initial survey was called negative

A 6 month old, previously reported as a "robust," healthy boy, presented with the mother reporting that when she tried to change his diaper, she "heard a crack." Also noted were periorbital small skin abrasions bilaterally. An ophthalmologic examination was negative; a skeletal survey noted a left femoral fracture. Routine bone scintigraphy was undertaken for suspected child abuse. This scan was positive and the child was recalled for another skeletal survey. This second skeletal survey noted a contralateral femoral subperiosteal reaction which, together with a healing femoral classic metaphyseal lesion, strongly suggested nonaccidental injury. © 2007 Lippincott Williams & Wilkins, Inc.