Bilateral Skull Fractures in an Infant: Diagnostic Dilemma Between Accident and Abuse.

Accidental head injury in infants is relatively common in the emergency department. However, abusive head trauma (AHT) should be considered in the differential diagnosis because of its strong association with morbidity and mortality. A 4-month-old male infant was admitted to the emergency department by his parents because of bilateral scalp swelling. Skull radiography and head computed tomography with three-dimensional reconstruction revealed bilateral linear parietal skull fractures. Although bilateral skull fractures are more commonly associated with AHT than single linear skull fractures, they may also result from a single accidental impact. Because skull fracture patterns alone cannot exclude AHT, a comprehensive medical evaluation is essential. If clinicians have even a slight suspicion of AHT, they should not hesitate to consult the hospital child protection team or Child Protective Services.