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Logo of bmjThis ArticleThe BMJ
BMJ. 2007 May 26; 334(7603): 1120.
PMCID: PMC1877952


Ajit Singh Kashyap, department of endocrinology, Command Hospital (Central), Lucknow, India, Kuldip Parkash Anand, Command Hospital (Eastern), Kolkata, India, Dalbara Singh, department of radiology, Command Hospital (Central), Lucknow, and Surekha Kashyap, Command Headquarters (Central), Medical Branch, Lucknow

A 7 year old girl was referred for suspected child abuse leading to multiple fractures of her skull. Clinically, the patient had short stature, with a bone age of 3 years, and features of congenital primary hypothyroidism. The skull anteroposterior x ray shows intrasutural or “wormian” bones along the coronal sutures, erroneously labelled as fracture.fracture. The anterior fontanelle is visualised (delayed closure). The skull is brachycephalic, and the paranasal sinuses and facial bones are poorly developed. Wormian bones are typical radiographic findings in congenital hypothyroidism, and they disappear at a bone age of 5 years.

figure min2605.f1

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