Spot diagnosis

2 years old boy complaint of right leg pain and noted to have right femur fracture. there is no history of trauma. fundus examination show as above.

what is likely the diagnosis?

answer:
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These retinal hemorrhages result from either blunt trauma to the head or rapid acceleration/deceleration injury, as in shaking. They may be the only verifiable signs of trauma, especially in "shaken baby syndrome."

What to do?

In suspected child abuse cases, examination of the retina is a critical step, particularly if other evidence is equivocal.