Non-accidental injury: a review of the radiology

Carty, Helen

doi:10.1007/s003300050303

Cited by 35 publications

(27 citation statements)

References 72 publications

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“…More difficult, especially in the near term infant, is ultrasonographic evaluation of the pericerebral and pericerebellar spaces and smaller intraparenchymatous lesions, especially at the brain convexity and the fossa posterior. They are evaluated in more detail with CT or MRI [15][16][17]. If necessary, skull fractures can be demonstrated with conventional imaging or CT [16].…”

Section: Discussionmentioning

confidence: 99%

Fetal trauma: brain imaging in four neonates

et al. 2004

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The purpose of this paper is to describe brain pathology in neonates after major traffic trauma in utero during the third trimester. Our patient cohort consisted of four neonates born by emergency cesarean section after car accident in the third trimester of pregnancy. The median gestational age ( n=4) was 36 weeks (range: 30-38). Immediate post-natal and follow-up brain imaging consisted of cranial ultrasound ( n=4), computed tomography (CT) ( n=1) and post-mortem magnetic resonance imaging (MRI) ( n=1). Pathology findings were correlated with the imaging findings ( n=3). Cranial ultrasound demonstrated a huge subarachnoidal hemorrhage ( n=1), subdural hematoma ( n=1), brain edema with inversion of the diastolic flow ( n=1) and severe ischemic changes ( n=1). In one case, CT demonstrated the presence and extension of the subarachnoidal hemorrhage, a parietal fracture and a limited intraventricular hemorrhage. Cerebellar hemorrhage and a small cerebral frontal contusion were seen on post-mortem MRI in a child with a major subarachnoidal hemorrhage on ultrasound. None of these four children survived (three children died within 2 days and one child died after 1 month). Blunt abdominal trauma during pregnancy can cause fetal cranial injury. In our cases, skull fracture, intracranial hemorrhage and hypoxic-ischemic encephalopathy were encountered.

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Section: Discussionmentioning

confidence: 99%

Fetal trauma: brain imaging in four neonates

et al. 2004

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“…Most often they occur when a child falls out of the cradle, off a sofa, downstairs ... and produce a relatively minor trauma (29). Fractures that result from abuse are often complex, multiple, bilateral, they cross suture lines and they are associated with intracranial injury (30). On the one hand fractures are a sign of abuse, but on the other hand they are very often the result of accidental trauma, which means that it is necessary to interpret the type and location of fracture with the clinical history, performed by an experienced and trained radiologist (31).…”

Section: Fracturesmentioning

confidence: 99%

The physician's role in recognizing physical abuse of children

Mikulic¹,

Jurišić²

2013

Paediatr Today

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Physicians are in frequent and regular contact with children and families through regular check-ups of pregnant women, newborns, and children of preschool and school-age. Therefore, physicians are in a unique position to effectively detect risk or detect abuse and neglect in good time and initiate the process of providing assistance to protect the child and allow him/her recovery and further undisturbed development. This paper discusses definitions of physical abuse, risk factors and the most common forms of physical abuse, the differences between accidental and non-accidental injuries, and the protocol for professional action in cases of child abuse. Conclusion -Physical abuse of children is a common occurrence, and it carries a significant morbidity and mortality rate. Given that abuse often has a transgenerational character, early recognition and intervention with at-risk families have a preventive character in relation to the next generation.

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“…Aufgrund einer Wachstumsstörung einer Extremität kann u. U. noch Jahre später ein nichtakzidentelles Trauma bzw. eine epiphysäre Läsion als Misshandlungsfolge vermutet werden [4,18]. …”

Section: Alter Des Traumasunclassified

Bildgebende Diagnostik der Kindesmisshandlung

2008

Monatsschr Kinderheilkd

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In der Diagnostik der Kindesmisshandlung ist die Bildgebung ein wesentlicher Faktor. Trotz scheinbar leerer Anamnese gelingt es, typische Verletzungsmuster als Misshandlungsfolge zu erkennen, sowohl im Bereich des Skeletts, der Weichteile, des Abdomens ("battered child syndrome", heute: "non accidental injury", NAI) als auch im ZNS ("shaken baby syndrome"). Den klinischen Symptomen entsprechend, wird im Verdachtsfall ein adäquates diagnostisches Verfahren eingesetzt, das erwartete charakteristische Befunde nachweist, den Mechanismus der Verletzung aufzeigt und das Alter der Läsionen annähernd festlegt. Radiologische Skelettbefunde werden hinsichtlich ihrer Spezifität für eine Misshandlung bewertet. Alle Resultate der Bildgebung sind zusammen mit Anamnese und klinischen Befunden zu deuten. Bei schwerer Misshandlung ohne äußere Verletzungszeichen ist das rechtzeitige Erfassen einer ZNS-Verletzung prognostisch bedeutsam. Initial wird bei diesem Verdacht die CT eingesetzt, um Blutung und Ödem darzustellen, im Verlauf werden mittels MRT Blutungsreste sowie residuelle parenchymatöse Läsionen erfasst. Alle Befunde sind auf ihre Differenzialdiagnosen hin zu prüfen, bevor der Misshandlungsverdacht geäußert wird. AbstractDiagnostic imaging in child abuse plays an important role and includes the depiction of skeletal injuries, soft tissue lesions, visceral injuries in "battered child syndrome" and brain injuries in "shaken baby syndrome". The use of appropriate imaging modalities allows specific fractures to be detected, skeletal lesions to be dated and the underlying mechanism of the lesion to be described. The imaging results must be taken into account when assessing the clinical history, clinical findings and differential diagnoses. Computed tomography (CT) and magnetic resonance imaging (MRI) examinations must be performed in order to detect lesions of the central nervous system (CNS) immediately. CT is necessary in the initial diagnosis to delineate oedema and haemorrhages. Early detection of brain injuries in children with severe neurological symptoms can prevent serious late sequelae. MRI is performed in follow-up investigations and is used to describe residual lesions, including parenchymal findings.

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Non-accidental injury: a review of the radiology

Cited by 35 publications

References 72 publications

Fetal trauma: brain imaging in four neonates

Fetal trauma: brain imaging in four neonates

The physician's role in recognizing physical abuse of children

Bildgebende Diagnostik der Kindesmisshandlung

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