Child Abuse: Practical Application of Autopsy, Radiological, and Microscopic Studies*

Abstract

A 17-month-old male infant died at home. The infant's right arm was immobilized because of a humeral fracture 1 month earlier. The circumstances of death appeared unclear to the police investigators and a medicolegal autopsy was carried out. External examination revealed diffuse ecchymoses of varying color. Postmortem imaging was performed prior to autopsy (X-rays, multislice computed tomography [MSCT], and focused brain magnetic resonance imaging [MRI]). These investigations revealed four rib fractures of varying ages, one of which was posterior. Cerebral and pericerebral traumatic lesions were also diagnosed: bilateral subdural hematomas, intraventricular, meningeal, and interpedoncular hemorrhages. In the abdomen, fresh blood was visible within the anterior abdominal wall and the mesenteric root. Autopsy and microscopic study confirmed these lesions. This case report illustrates the valuable assistance rendered by MSCT and MRI to diagnose abuse when a child has died in unclear circumstances.

Pattern of injury in child fatalities resulting from child abuse

“…Another contributing factor could be the inability to detect antemortem or perimortem fractures using conventional diagnostic procedures. Dedouit et al [24] found that multislice computed tomography (MSCT) was a more effective screening method for evaluating skeletal injuries than conventional X-rays. In a swine model study comparing autopsy, radiological, and tomographic diagnostic procedures, Cattaneo et al [25] reported that traditional radiology detected only 47% of fractures, while CT scans detected 34% and autopsy 65%.…”

Lethal visceral traumatic injuries secondary to child abuse: A case of practical application of autopsy, radiological and microscopic studies

“…Postmortem imaging has already been successfully used in cases of suspected child abuse, particularly when brain or rib injuries occur [20,21]. This case is a good illustration of the limitations of MSCT.…”

The Anesthesiologist’s Role in Treating Abusive Head Trauma

“…88,89 Less than 10% of child abuse cases involve serious intraabdominal injuries. 85,90 Nonetheless, all children with suspected abuse must be screened for abdominal injuries because even the most severe injuries can be difficult to diagnose.…”