Radiographs of the skull would most often not alter one's clinical approach except in a case such as this. This skull series shows extensive fractures of the right parietal skull. One would expect to see a simple linear fracture in this region if the trauma were accidental. Additionally, there are extensive fractures over the occipital skull and the contralateral parietal skull as well. A simple fall off a couch could not possibly account for all these fractures.
Child abuse is likely.
A CT scan of the brain is performed. View CT scan. This high CT scan cut shows a bone window on the left and a brain window on the right. The open anterior fontanelle is noted at the top of the both images. The bone window on the left shows a large right parietal fracture.