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Radiological Mimickers of Physical Child Abuse
Published in B. G. Brogdon, Tor Shwayder, Jamie Elifritz, Child Abuse and Its Mimics in Skin and Bone, 2012
B. G. Brogdon, Tor Shwayder, Jamie Elifritz
Clinically, newborns may exhibit failure to thrive, fever, irritability, rashes, saddle nose deformities, hepatosplenomegaly, and rashes on the palms of the hands and the soles of the feet. Older children may exhibit abnormally notched teeth (referred to as Hutchinson teeth), blindness, and impaired hearing/deafness. Approximately 25% of children with congenital syphilis will have bony manifestations that can simulate nonaccidental trauma.16 The archetypal descriptions of congenital syphilis with radiographic correlations were made in the 1930s.17–19 Lucent transverse metaphyseal bands, metaphyseal erosions, and irregular lytic defects are common (Figure 3.19). Periosteal reactions and pathologic fractures are also well-known responses to syphilitic osteomyelitis. Fractures commonly occur through the metaphyses due to damage from syphilitic gummatous granulation tissue20 (Figure 3.20). Skeletal changes most often involve the tibia, femur, and humerus. Bowing of long bones, such as saber shin, is a typical feature in older victims. Congenital syphilis seen originally as a skeletal lesion can easily be mistaken for child abuse.21
Musculoskeletal Infection
Published in Harry Griffiths, Musculoskeletal Radiology, 2008
The patient may also have Hutchinson’s teeth, which are curious, pointed teeth, and there are some skin and nerve changes including eighth nerve deafness. Several of the patients develop saber shins, which is an anterior curvature of the tibias bilaterally (Fig. 69A, B).
Principles of Clinical Diagnosis
Published in Susan Bayliss Mallory, Alanna Bree, Peggy Chern, Illustrated Manual of Pediatric Dermatology, 2005
Susan Bayliss Mallory, Alanna Bree, Peggy Chern
Develops >2 years of age Cutaneous findings: rhagades, gummataExtracutaneous findings:NeurosyphilisInterstitial keratitisSensorineural hearing lossBony changes (saddle nose, frontal bossing, saber shins, syphilitic arthritis, Clutton joints (effusions of the knees),
Fetal and Placental Pathology in Congenital Syphilis: A Comprehensive Study in Perinatal Autopsy
Published in Fetal and Pediatric Pathology, 2018
Napaputch Kittipornpechdee, Suchanan Hanamornroongruang, Duanphen Lekmak, Jitsupa Treetipsatit
Twenty of 21 (95.2%) cases demonstrated one or more fetal abnormalities. All the identified fetal abnormalities are summarized in Table 1 and Figures 1 and 2. Regarding the thymic abnormalities, besides the significant decrease in thymic weight to under 10 percentiles, three different histopathologic features that are associated with stress during intrauterine life were noted: acute stress involution, chronic stress involution, and fatty infiltration. Acute stress involution (Fig. 1(D)) is characterized by pronounced lymphophagocytosis in the thymic cortex, which results in exposure of the epithelial cells and a “starry-sky” appearance associated with shrinkage of the cortex and some separation of the thymic lobules. Chronic stress involution (Fig. 1(E)) is characterized by marked depletion of the cortical lymphocytes, which results in an almost total loss of corticomedullary demarcation, and shrinkage and separation of the thymic lobules. Fatty infiltration (Fig. 1(F)), glucocorticoids-induced change, is recognized as infiltration of adipocytes within the thymus. Of all the aforementioned thymic abnormalities, chronic stress involution was identified in more than 50%, either as an isolated thymic pathology or a co-existing abnormality with others. Dubois’s microabscesses were not identified. Regarding the abnormalities of fetal organs, hepatomegaly was found in association with splenomegaly (chi-square test, p = .040). Common histologic changes in the enlarged liver and spleen were sinusoidal congestion and extramedullary hematopoiesis. Inflammatory response to the infection was observed in fetal organs in a subset of cases. Lung was most commonly involved. Histologic changes in the inflamed fetal lungs included infiltration of lymphocytes and plasma cells in the interstitium and pleura (Fig. 2(B,C)). Features characteristic of pneumonia alba were not identified grossly. In cases where fetal radiographs were abnormal, only irregularities of metaphyses of long bones were noted. None showed the “saber shin” appearance. Of note, an association between inflammation in fetal organs and metaphyseal abnormalities in fetal radiographs was observed (chi-square test, p = .022). None demonstrated microphthalmia, microcephaly, or intracranial calcification. Of all nonmacerated cases, none showed mucocutaneous lesions.