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Child Abuse
Battered Child Syndrome
- Most common cause of serious intracranial injuries
in children less than 1 year of age
- 3rd most common cause of death in children after
sudden infant death syndrome and true accidents
- Prevalence
- 1.7 million cases reported, 833,000 of which were
substantiated in United States in 1990
- Results in 2,500-5,000 deaths/year
- 5-10% of children seen in emergency rooms suffer
from child abuse
- Radiologist has legal obligation to report suspected
child abuse, usually to the referring physician
- Age
- In children <2 years of age, a skeletal survey may
be best to demonstrate other fractures
- In children >2 years of age, a bone scan may be
best
- Clinical findings
- Skin burns
- Bruises
- Lacerations
- Hematomas
- Skeletal trauma is seen in 50-80%
Skeletal Trauma Suspicious for Child
Abuse
|
Site(s) |
Remarks |
Distal
Femur, distal humerus, wrist, ankle |
Metaphyseal corner fractures |
Multiple |
Fractures in different stages of healing |
Femur,
humerus, tibia |
Spiral
fractures < 1 year of age |
Posterior ribs, avulsed spinous processes |
Unusual
“naturally-occurring” fractures <5years of age |
Multiple
skull fractures |
Multiple
fractures of occipital bone should suggest child abuse |
Fractures with abundant callous formation |
Implies
repeated trauma and no immobilization |
Metacarpal and metatarsal fractures |
Unusual
“naturally-occurring” fractures <5years of age |
Sternal
and scapular fractures |
Vertebral body fractures and subluxations |
- Sites of skeletal trauma
- Multiple ribs
- Transverse fracture of sternum
- Costochondral / costovertebral separation
- Lateral end of clavicles
- Scapula
- Acromion
- Skull
- Vertebral bodies
- Anterior-superior wedging of vertebral bodies
- Vertebral compression
- Vertebral fracture dislocation
- Disk space narrowing
- Spinous processes
Frontal radiograph of
the chest demonstrates multiple rib fractures with callous formation,
including a fracture of the left 2nd and 6th ribs posteriorly.
Posterior rib fractures are highly suggestive of child abuse (from
forceful squeezing)
- Appearances of skeletal trauma
- Hallmark of the syndrome are multiple,
asymmetric fractures in different stages of healing
- Separation of distal epiphysis
- Marked irregularity and fragmentation of
metaphyses
- "Corner" fracture (11%) or "Bucket-handle"
fracture = avulsion of a metaphyseal fragment overlying the
lucent epiphyseal cartilage secondary to a sudden twisting
motion of extremity
- Isolated spiral fracture (15%) of diaphysis
secondary to external rotatory force applied to femur / humerus
- Extensive periosteal reaction from large
subperiosteal hematoma
- Exuberant callus formation at fracture sites
- Cortical hyperostosis extending to
epiphyseal plate
- Avulsion fracture at site of ligamentous
insertion
- Frequently seen without periosteal
reaction
- Head trauma (13-25%)
- Most common cause of death and/or physical
disability
- Skull fracture (flexible calvaria +
meninges decrease likelihood of skull fractures)
- Subdural hematoma
- Brain contusion
- Cerebral hemorrhage
- Infarction
- Generalized edema
- Shearing injuries with associated
subarachnoid hemorrhage
- Skull film (associated fracture in 1%):
- Linear fracture > comminuted fracture
- CT findings in head trauma
- Subdural hemorrhage (most common)
- Interhemispheric location most common
- Subarachnoid hemorrhage
- Epidural hemorrhage (uncommon)
- Cerebral edema (focal, multifocal,
diffuse)
- Acute cerebral contusion appears as ovoid
collection of intraparenchymal blood with surrounding edema
- MR findings of head trauma
- More sensitive in identifying hematomas of
differing ages
- White matter shearing injuries as areas of
prolonged T1 + T2 at corticomedullary junction, centrum
semiovale, corpus callosum
- Viscera (3%)
- Second leading cause of death in child abuse
- Cause
- Crushing blow to abdomen (punch, kick)
- Age
- Small bowel and/or gastric rupture
- Hematoma of duodenum and/or jejunum
- Contusion and/or laceration of lung,
pancreas, liver, spleen, kidney
- Traumatic pancreatic pseudocyst
- Differential diagnosis of child abuse
- Normal periostitis of infancy
- Osteogenesis imperfecta
- Congenital insensitivity to pain
- Infantile cortical hyperostosis
- Menkes kinky hair syndrome
- Schmid-type chondrometaphyseal dysplasia
- Scurvy
- Congenital syphilitic metaphysitis
Child abuse. Frontal and oblique views of the radius demonstrate multiple fractures present at the metaphysis of the distal radius (white arrows). A history of child abuse was elicited.
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Dahnert 5th edition
Requisites-Pediatric
Radiology
Requisites-Musculoskeletal Radiology
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