Retinal Hemorrhages in Nonaccidental Trauma: Look at Susceptibility-Weighted Imaging on Pediatric MRI

Abstract

This 2-month-old boy presented to the emergencydepartment with vomiting, lethargy, and episodes of apneaafterapparentlyfallingfromhisfather’slapwhilehisdiaperwas changed one day earlier. On examination, he waswell-nourished and inno acutedistress; hisvital signswerenormal. A hematoma was noted over the left foreheadand parietal region. A head computed tomographyrevealed a comminuted right parietal skull fracture withbilateral subdural hematomas. A brain magnetic resonanceimaging (MRI) confirmed bilateral subdural hematomas(right > left) and showed additional subdural blood alongthe tentorium (Fig. 1A). On trace of diffusion and apparentdiffusion coefficient maps, multiple scattered foci ofrestricted diffusion were seen at the corticomedullaryjunction within both hemispheres suggestive of diffuseaxonal injury (Fig 1B,C). Susceptibility weighted imaging(SWI) revealed multiple hypointense foci along the pe-riphery of both eye globes consistent with retinal hemor-rhages (Fig 2), which in combination with the diffusiontensor imaging findings and extra-axial hemorrhage, raised