www.ijcasereportsandimages.com Rib fractures: Accidental or non-accidental Muhammad Waseem, Evelyn Erickson ABSTRACT Introduction: We report an incidental discovery of multiple rib fractures in a wheezing child without a history of an injury or the presence of metabolic bone disease. As a result, the child was evaluated for the presence of non- accidental trauma. Case Report: An 11-month- old African-American child was brought to the emergency department by his father with a 2- day history of fever, cough and breathing difficulty. After receiving nebulizer treatments, the child was still wheezing. A chest X-ray was obtained which showed bilateral fractures of the ribs. No history of trauma was provided. Given the radiographic findings, Child Protective Services was contacted and a report of child abuse was made. Conclusion: Child abuse is a complex phenomenon. Any skeletal injury in young children can be due to abuse. Rib fractures are uncommon in the pliable chest of a child. When discovered, however, they raise the suspicion of a non-accidental trauma. They are often uncovered during the assessment of children who present to the emergency department for unrelated reasons. The physician's ability to differentiate accidental from non-accidental trauma may depend on gathered information. This report emphasized the importance to evaluate for non-accidental trauma after the finding of bilateral rib fractures on a chest X-ray. Non-accidental trauma should be considered when there is evidence of injury without a history of trauma. Keywords: Non-accidental trauma, Rib fractures, Child abuse ********* Waseem M, Erickson E. Rib fractures: Accidental or non-accidental. International Journal of Case Reports and Images 2013;4(1):58–61. ********* doi:10.5348/ijcri-2013-01-260-CR-14 INTRODUCTION Rib fractures are uncommon in infants and children. Non-accidental trauma is a common cause of morbidity and mortality in young children, but the diagnosis is not always apparent. Most abused children present without a plausible explanation for their injuries. In the absence of a documented history of significant injury or the presence of metabolic bone disease, non-accidental trauma is the most likely presumed diagnosis. We report an incidental discovery of multiple rib fractures in a wheezing child. CASE REPORT An 11-month-old African-American, asthmatic child was brought by his father to the emergency department during the winter with a two-day history of fever, cough and breathing difficulty. On arrival, he was noted to be wheezing and was directly brought to the asthma room.