Diagnostic Imaging in Child Abuse

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.