E2531. Pediatric Nonaccidental Trauma: What Does the Radiologist Need to Know?
Authors
Ankita Chauhan;
University of Tennessee Health Science Center/Le Bonheur Children's Hospital
Muhammad Ramzan;
University of Tennessee Health Science Center/Le Bonheur Children's Hospital
Background
More than five children die each day in the United States because of abuse and neglect, with many cases likely unreported. Head injury after nonaccidental trauma (NAT) is one of the leading causes of mortality and morbidity in infants and children. Visceral trauma is the second leading cause of death in child abuse after central nervous system injury. Any organ can be injured following child abuse, but the common three sites are the liver, the hollow viscera (mainly duodenum and jejunum), and the pancreas. Our exhibit gives a comprehensive review of pediatric NAT.
Educational Goals / Teaching Points
Become familiar with the features raising suspicion of NAT and the imaging approach one should take when abuse is suspected, illustrate the imaging spectrum of findings in a child with intentional trauma, acquire a basic understanding of the classic skeletal injuries for NAT and learn how to date these fractures, and review the mimickers of NAT.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
A radiologist must recognize the characteristic features of NAT to prevent future injuries to the child. Imaging plays a vital role in detecting the type and extent of abusive injuries. Certain imaging features particularly suggest abuse. A skeletal survey should be performed if abuse is suspected in a child under two years of age. Imaging not only identifies the extent of physical injury but also helps rule out alternative diagnoses. One should apply the exposure principle of ALARA (as low as reasonably achievable) to image children. The court frequently asks pediatric radiologists to date a fracture in a child with suspected abuse. An abused child can sustain appendicular and axial skeletal injuries, retinal and intracranial hemorrhages, diffuse cerebral ischemia, diffuse axonal injury, or visceral trauma. Radiologists should be wise in deciding which modality to go for based on multiple factors, including clinical suspicion and the patient’s age.
Conclusion
Clinical history, physical examination, and good communication with pediatric physicians help plan the appropriate imaging workup of pediatric patients with suspected abuse. Depending on the presenting symptoms, the differential diagnosis and the choice of imaging modality vary. We will illustrate the imaging spectrum of NAT in the pediatric age group and discuss various radiological features that can help make the correct diagnosis.
