Abdominal imaging in child abuse

Area of Science:

• Pediatric Radiology
• Child Abuse Detection
• Forensic Imaging

Background:

• Abdominal injuries in abused children, though less common than other trauma types, have high mortality and morbidity.
• Radiologists play a crucial role in documenting and evaluating injuries in all trauma cases, irrespective of cause.
• Identifying inflicted abdominal injuries requires a high index of suspicion due to the lack of specific injury patterns.

Purpose of the Study:

• To highlight the importance of considering child abuse in cases of unexplained acute abdominal symptoms in young children.
• To outline key clinical indicators and imaging modalities for diagnosing inflicted abdominal injuries in pediatric patients.

Main Methods:

• Computed Tomography (CT) with intravenous contrast is the primary imaging modality for suspected inflicted abdominal injuries.
• Ultrasound (US) serves as an initial imaging test for low-probability cases and for follow-up examinations.
• Upper gastrointestinal series can aid in evaluating mural hematomas when CT or US findings are equivocal.

Main Results:

• No specific abdominal injury pattern is pathognomonic for physical abuse; a broad range of injuries can occur.
• Clinical suspicion should be raised by factors such as delayed medical attention, history of trauma, young age, malnutrition, and implausible injury explanations.
• Specific organ injuries (pancreatic, hollow visceral, solid organ) warrant heightened vigilance for potential abuse.

Conclusions:

• Child abuse must be included in the differential diagnosis for acute abdominal conditions in pediatric patients.
• Prompt and accurate radiological assessment is vital for the timely identification and management of inflicted abdominal trauma.