AMA Radiology

4 year old in emergency department with chest pain.

Radiograph of the chest in a child. Multiple bilateral rib fractures are demonstrated.  These are of different ages.  No pneumothorax.  No lung consolidation.  The heart is not appear to be enlarged.  The appearance on imaging is concerning for potential nonaccidental injury.  Differential diagnosis includes underlying bone disease such as osteogenesis imperfecta. I would in my normal practise urgently discuss the case with the referring physician to guide future management.