Variations in acromial ossification simulating infant abuse in victims of sudden infant death syndrome

A variation in ossification of the acromial process of the scapula is described. Postmortem radiographs, obtained in 78 infants who died of sudden infant death syndrome, showed an ossific opacity adjacent to the acromial process in 10 infants (13%). This finding was noted bilaterally in six patients and unilaterally in four patients. No two ossicles were identical. Histologically, no growth plate cartilage was evident between the bony structure and the acromion proper; therefore, this appeared to represent a "pseudoepiphysis." Superficially, this normal variation may appear similar to an acromial fracture resulting from infant abuse. However, a careful analysis of the findings of this normal variation should help prevent any confusion with inflicted injury.