From the Archives of the AFIP

Abstract

In the United States, roughly one of every 100 children is subjected to some form of neglect or abuse; inflicted injury is responsible for approximately 1,200 deaths per year. Child physical abuse may manifest as virtually any injury pattern known to medicine. Some of the injuries observed in battered children are relatively unique to this population (especially when observed in infants) and therefore are highly suggestive of nonaccidental, or inflicted, injury. Worrisome injuries include rib fracture, metaphyseal fracture, interhemispheric extraaxial hemorrhage, shear-type brain injury, vertebral compression fracture, and small bowel hematoma and laceration. As noted, however, virtually any injury may be inflicted; therefore, careful consideration of the nature of the injury, the developmental capabilities of the child, and the given history are crucial to determine the likelihood that an injury was inflicted. The majority of these injuries are readily detectable at imaging, and radiologic examination forms the mainstay of evaluation of child physical abuse. Detection of metaphyseal fracture (regarded as the most specific radiographically detectable injury in abuse) depends on high-quality, small field-of-view radiographs. The injury manifests radiographically as a lucent area within the subphyseal metaphysis, extending completely or partially across the metaphysis, roughly perpendicular to the long axis of the bone. Acute rib fractures (which in infants are strongly correlated with abuse) appear as linear lucent areas. They may be difficult to discern when acute; thus, follow-up radiography increases detection of these fractures. For skull injuries, radiography is best for detecting fractures, but computed tomography and magnetic resonance imaging best depict intracranial injury.

Clinical and Radiologic Findings of Inner Ear Involvement in Sickle Cell Disease

“…The term SCD applies to all patients with at least a single HbS chain and 1 other abnormal ␤ globin chain, which may be another sickle cell ␤ chain (in which case the patient is homozygous HbSS and by definition has sickle cell anemia), HbC (HbSC), or 1 of the thalassemias (HbS/␤-thalassemia). 1,2 The spectrum of clinical manifestations of SCD is broad and can involve virtually any organ system. Pathologic changes of SCD are based on the 3 mechanisms: vaso-occlu- …”

“…[1][2][3] The most accepted pathogenesis of inner ear involvement is recurrent vaso-occlusion of the labyrinthine blood vessels, which can result in LH and LO. [3][4][5][6][7][8][9] LH is thought to result from altered capillary hemodynamics or reperfusion injury.…”

“…1,2 The spectrum of clinical manifestations is broad and can involve virtually any organ system, including inner ear. 3 SNHL is a well-recognized complication of SCD.…”

Adult post-mortem imaging in traumatic and cardiorespiratory death and its relation to clinical radiological imaging

“…[39][40][41] However, there is a lack of evidence to show that PMCT can do this, showing that the ability of PMCT to detect trauma to the bone, in general, is not enough, as specific injuries such as the characteristic "bucket handle" metaphyseal fractures must be confidently excluded. 42 MRI may be sensitive to these metaphyseal fractures, 31,43 and it is therefore unlikely that CT would be used in living patients owing to radiation exposure.…”

Chronic Liver Disease among Adult Patients with Sickle Cell Anemia in Steady State in Ile-Ife, Nigeria

“…Repeated vascular occlusion, chronic hemolysis with increased excretion of bilirubin and deposition of pigments, long-standing anemia, repeated transfusions leading to iron overload and transfusional hemosiderosis, stagnation of sickled red cells in the hepatic sinusoids with sinusoidal obstruction, vascular occlusion by agglutinative thrombi, and infections, especially chronic viral hepatitis all contribute to the pathogenesis of the multiple hepatobiliary manifestations of sickle cell anemia [10,11] .…”