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Retroclival collections associated with abusive head trauma in children

  • Special Issue: Abusive Head Trauma
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

Retroclival collections are rare lesions reported almost exclusively in children and strongly associated with trauma. We examine the incidence and imaging characteristics of retroclival collections in young children with abusive head trauma. We conducted a database search to identify children with abusive head trauma ≤3 years of age with brain imaging performed between 2007 and 2013. Clinical data and brain images of 65 children were analyzed. Retroclival collections were identified in 21 of 65 (32%) children. Ten (48%) were subdural, 3 (14%) epidural, 2 (10%) both, and 6 (28%) indeterminate. Only 8 of 21 retroclival collections were identifiable on CT and most were low or intermediate in attenuation. Eighteen of 21 retroclival collections were identifiable on MRI: 3 followed cerebral spinal fluid in signal intensity and 15 were bloody/proteinaceous. Additionally, 2 retroclival collections demonstrated a fluid-fluid level and 2 enhanced in the 5 children who received contrast material. Sagittal T1-weighted images, sagittal fluid-sensitive sequences, and axial FLAIR (fluid-attenuated inversion recovery) images showed the retroclival collections best. Retroclival collections were significantly correlated with supratentorial and posterior fossa subdural hematomas and were not statistically correlated with skull fracture or parenchymal brain injury. Retroclival collections, previously considered rare lesions strongly associated with accidental injury, were commonly identified in this cohort of children with abusive head trauma, suggesting that retroclival collections are an important component of the imaging spectrum in abusive head trauma. Retroclival collections were better demonstrated on MRI than CT, were commonly identified in conjunction with intracranial subdural hematomas, and were not significantly correlated with the severity of brain injury or with skull fractures.

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Authors and Affiliations

  1. Department of Radiology, Boston Children’s Hospital, Harvard Medical School, 300 Longwood Ave, 02115, Boston, MA, USA

    V. Michelle Silvera, Amy R. Danehy, Catherine Stamoulis, Chiara Carducci, P. Ellen Grant & Paul K. Kleinman

  2. Child Protection Program, Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA

    Alice W. Newton

  3. Department of Neurology, Boston Children’s Hospital, Harvard Medical School, Boston, MA, 02115, USA

    Catherine Stamoulis

  4. Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, 02115, USA

    Celeste R. Wilson

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  1. V. Michelle Silvera
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  2. Amy R. Danehy
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  3. Alice W. Newton
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  4. Catherine Stamoulis
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  5. Chiara Carducci
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  8. Paul K. Kleinman
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Correspondence to V. Michelle Silvera.

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Silvera, V.M., Danehy, A.R., Newton, A.W. et al. Retroclival collections associated with abusive head trauma in children. Pediatr Radiol 44 (Suppl 4), 621–631 (2014). https://doi.org/10.1007/s00247-014-3170-2

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  • DOI: https://doi.org/10.1007/s00247-014-3170-2

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