BMJ 2007; 334 doi: http://dx.doi.org/10.1136/bmj.39219.687894.BE (Published 24 May 2007) Cite this as: BMJ 2007;334:1120
  1. Ajit Singh Kashyap, department of endocrinology, Command Hospital (Central), Lucknow, India,
  2. Kuldip Parkash Anand, Command Hospital (Eastern), Kolkata, India,
  3. Dalbara Singh, department of radiology, Command Hospital (Central), Lucknow,
  4. Surekha Kashyap, Command Headquarters (Central), Medical Branch, Lucknow
  1. kashyapajits{at}gmail.com

    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. 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.

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