Neoplasia masquerading as physical abuse

We describe three children with organic disease presenting as possible physical abuse. The first child was an infant with an ‘unexplained’ transverse fibular fracture, who was initially placed on the child protection register. Subsequent progress and investigation revealed that the fracture was caused by a haemangioma arising from the surrounding tissues. Two further children presented with bruising, in one case due to acute lymphoblastic leukaemia and in the other neuroblastoma. In both, the correct diagnosis became evident following assessment by an experienced paediatrician. These cases demonstrate the importance of obtaining an accurate history and of performing a careful examination when considering physical abuse, but also the need to review that diagnosis if subsequent contradictory evidence comes to light. Copyright © 2000 John Wiley & Sons, Ltd.