Diagnostic Imaging in Child Abuse Non Accidental Trauma

Introduction Role of the Radiologist Skeletal Injury Corner fracture Rib fractures Skull fractures Diaphyseal fractures Fracture healing CNS injury Subdural hematoma Other injuries Imaging survey in suspected abuse Differential diagnosis ROTEIRO DE APRESENTAÇÃO

Introduction Child abuse is a relatively common problem in our society. In the U.S it is estimated that 4 million children a year are abused in some manner. At least two thousand children die as a result of this abuse. This overview focusses on the role of diagnostic imaging in depicting the findings that are specific for child abuse. Awareness of the radiologist is essential in finding these skeletal and CNS injuries in order to document child abuse, to stop further abuse and to protect siblings. INTRODUÇÃO

Introduction Battered child syndrome, shaken infant syndrome, stress-related infant abuse and non accidental trauma are all terms to describe the complex of non-accidental injuries in infants and young children as a result of abuse. The term shaken infant syndrome probably best describes the classic pattern of injuries. The child is held around the chest and violently shaken back and forth. INTRODUÇÃO

Introduction This causes the extremities and the head to flail back and forth in a whiplash movement. Intracranial injury occurs as a result of severe angular acceleration, deceleration and direct impact as the head strikes a solid object. The chest is compressed resulting in rib fractures. Arms and legs move about in a whiplash movement resulting in the typical 'corner' or 'bucket-handle'-fractures in the metaphyseal region. INTRODUÇÃO

Role of the Radiologist Papel do Radiologista The ability to identify child abuse constitutes an important concern to those involved in the medical care of children. Studies show that at least 10% of children under 5 years old who are brought to the emergency room with alleged accidents have actually suffered nonaccidental trauma. Since as many as 65% of all abuse cases are initially seen in the emergency room, the first step in correctly identifying abuse is to train hospital staff members to recognize abuse indicators. The future safety of a child with the shaking infant syndrome rests on the radiologist's ability to recognize these characteristic features.

Role of the Radiologist Papel do Radiologista

Skeletal Injury

Corner fracture