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Diagnostic Imaging in Child Abuse

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Imaging Trauma and Polytrauma in Pediatric Patients

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Abstract

Child abuse is an important cause of death and morbidity, especially in young children. Girls are abused slightly more often than boys. Clinical features include bruises; lacerations; scratches; burns or scalds; eye, head, and visceral injuries; boxer’s nose; poisoning; suffocation; fractures; and genital and anal injury. In 1946, Caffey described six infants with subdural hematomas and later metaphyseal fractures which are considered to date the most specific injury in child abuse. In 1962, Kempe et al. coined the term battered child syndrome; in 1971, Guthkelch named it “shaken baby syndrome”. Actually “non-accidental injury (NAI)” is mostly employed to define this condition. Imaging plays an important role in the detection and documentation of NAI, differentiating abuse from accidental trauma, normal variants, metabolic bone diseases, and skeletal dysplasias. Some patterns of lesions are highly suggestive of non-accidental trauma, and therefore, it is essential to recognize the typical radiological signs. Skeletal injuries are the most common injuries in NAI. Fractures are documented in near 50 % of physically abused children and, when present, generally suggest the correct diagnosis. Thoraco-abdominal visceral lesions from NAI are not common, representing 2–4 % of injuries, with a high mortality rate. Most injuries occur in the duodenum and in proximal jejunum. A non-accidental head injury occurs in about 12 % of abused children and in children under 2 years of age, representing 80 % of deaths from head trauma. The lesions are skull fractures, extra-axial hemorrhage, brain parenchymal lesions and cerebral edema.

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Author information

Authors and Affiliations

  1. Department of Diagnostic Imaging, Bambino Gesù Children’s Hospital IRCCS, Rome, Italy

    Domenico Barbuti MD, Laura Tanturri de Horatio MD & Marco Cirillo MD

Authors
  1. Domenico Barbuti MD
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  2. Laura Tanturri de Horatio MD
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  3. Marco Cirillo MD
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Correspondence to Domenico Barbuti MD .

Editor information

Editors and Affiliations

  1. Department of Emergency Radiology, S. Camillo Hospital, Rome, Italy

    Vittorio Miele

  2. Department of Emergency Radiology, S. Camillo Hospital, Rome, Italy

    Margherita Trinci

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Barbuti, D., de Horatio, L.T., Cirillo, M. (2015). Diagnostic Imaging in Child Abuse. In: Miele, V., Trinci, M. (eds) Imaging Trauma and Polytrauma in Pediatric Patients. Springer, Cham. https://doi.org/10.1007/978-3-319-08524-1_7

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  • DOI: https://doi.org/10.1007/978-3-319-08524-1_7

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-08523-4

  • Online ISBN: 978-3-319-08524-1

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