and can lead to tearing of the bridging veins andresultant subdural or subarachnoid hematomas.
a—Cephalohematomas are com-mon parturitional injuries, especially in birthsinvolving instrumentation. They occur in 3% to10% of newborns.
In 25% of cases they areassociated with skull fractures, usually in theposterior parietal region.
Subdural hemorrhage related to the tentorium isassociated with vacuum extraction.
Chronic sub-dural collections seen in the ﬁrst months of life may be attributed to parturitional events, but examina-tion of those events will usually clarify whetherthere were factors during the birth that may havegiven rise to the collections seen later. The CTimaging characteristics and the absence of asso-ciated injuries (other fractures, RHs, abusive bruises)and the social history often can help distinguishthese conditions from parturitional injuries.
—Bilateral black eyes areusually from abuse, but they can be caused by blunttrauma to the forehead with resultant seepage of the extravasated blood into the periorbital tissues.
—Forceful coughing,sneezing, vomiting, or other Valsalva maneuvers cancause subconjunctival hemorrhages.
—Retinal hemorrhages must bedescribed in terms of their characteristics, becausenot all RHs are alike.
Retinal hemorrhages do notoccur as the result of cardiopulmonary resuscita-tion,
or thoracic compression inchildhood (Purtscher’s retinopathy).
Visual Diagnosis of Child Abuse on CD-ROM
11. CONDITIONS MISTAKEN FOR CHILD PHYSICAL ABUSE
TABLE 11-1. CONDITIONS CONFUSED WITH BRUISING
Condition Distinguishing Features
Mongolian spots•Slate gray and uniform in color from one side to the other•Seen at time of birth, become less visible slowly •Seen usually on buttocks, lower back, but can be seen anywhere onthe body Ehlers-Danlos syndrome(India rubber syndrome)•Skin is velvety, hyperelastic, and fragile•Minor trauma can lead to bruisesErythema multiformeHypersensitivity vasculitis•Splotchy, covering various areas of body •Often itchy, may be raised (hives)•Recurrent, indolentPhytophotodermatitis•Exposure to psoralens in the juice of certain plants followed by exposureto sunlight (limes, lemons, ﬁgs, parsnip, celery, herbal preparations)Millipedes secretions
•Mahogany-colored lesions from contact to skinContact dermatitis and allergic reactions •Rubber, face masks, surf boards, squash balls, elastic bands in clothing,plants, chemicalsLice, “crabs”•Can inject anticoagulant under the skin causing deposit of hemosiderinInk or dye on skin (clothing)•Mimics bruises or abrasionsCoagulation defect (hemophilia, vonWillebrand’s, leukemia, ITP, HSP, vitaminK deﬁciency, ingestion of anticoagulants•Coagulation studies—PT, PTT, TT, ﬁbrinogen, Factor VIII, platelets,special studies