Linear lucency of the skull vault: Fracture or accessory skull suture

• Published in: Legal medicine (Tokyo, Japan) Japan), 2022-02, Vol.54, p.101971-101971, Article 101971
• Main Authors: Koo, Zhao Peng, Siew, Sheue Feng, Chainchel Singh, Mansharan Kaur
• Format: Article
• Language: English
• Subjects: Accessory skull suture; Anomalous parietal suture; Child abuse; Cranial Sutures - diagnostic imaging; Humans; Infant; PMCT; Skull - diagnostic imaging; Skull fracture; Skull Fractures - diagnostic imaging; Sutures; Tomography, X-Ray Computed
• ISSN: 1344-6223; 1873-4162
• DOI: 10.1016/j.legalmed.2021.101971

•Diagnosis of an accessory skull suture can be challenging.•Accessory skull sutures may be misinterpreted as non-accidental injury.•Diagnosis requires detailed autopsy, radiological and histology examination.•Proper diagnosis will avoid unnecessary medical intervention and catastrophe. Sutures are a type of fibrous joint that occur only in the skull. However, partial or complete division of bones resulting in anomalous or accessory skull sutures may be misinterpreted as fractures when identified on radiological examination. Thus, it is of paramount clinical and medicolegal importance that these sutures be differentiated from actual fractures which can lead to severe consequences such as false accusation and mis-management of patient. It must be remembered though that the diagnosis in such cases is not straight forward even during postmortem examination which requires careful evaluation of findings with the aid of histology examination and radiology imaging. We present a case of a mis-diagnosis of an anomalous parietal suture in a three-month-old infant.