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Venous injury in pediatric abusive head trauma: a pictorial review
George Koshy Vilanilam1, Sateesh Jayappa2, Shivang Desai3
1Department of Radiology, University of Arkansas for Medical Sciences, 4301 W. Markham St., Slot 556, Little Rock, AR, 72205, USA. george.koshy.vilanilam@gmail.com.
Insights
Abusive head trauma (AHT) can cause severe intracranial injuries in young children, even with a normal physical exam. Early detection of venous injuries in AHT is crucial for timely intervention and preventing further harm.
Area of Science:
- Pediatric Radiology
- Neurology
- Forensic Pathology
Background:
- Abusive head trauma (AHT) is a leading cause of fatal head injuries in children under two years old.
- Intracranial pathology from AHT may not be apparent on physical examination.
- Delayed diagnosis of AHT has severe consequences, including increased risk of re-abuse.
Purpose of the Study:
- To review imaging features of intracranial venous injury in AHT.
- To summarize morpho-structural patterns of shearing injuries and bridging vein thrombosis.
- To facilitate early detection of AHT in the pediatric population.
Main Methods:
- Literature review of imaging findings in AHT.
- Focus on traumatic subdural hematoma and venous injuries.
- Analysis of morpho-structural patterns associated with AHT.
Main Results:
- AHT involves traumatic injury to bridging veins, causing partial or complete tears.
- Secondary thrombosis can occur at the terminal end of bridging veins.
- Imaging reveals characteristic patterns of intracranial venous injury.
Conclusions:
- Familiarity with imaging patterns aids in early AHT detection.
- Understanding venous injury mechanisms is key to diagnosis.
- Prompt diagnosis of AHT is critical for child safety and outcomes.
Abstract:
Abusive head trauma (AHT) is the leading cause of fatal head injuries in children younger than 2 years. An intracranial pathology can exist even in the setting of a normal physical exam. A delay in the diagnosis of AHT can have serious life-threatening consequences for the child and increases the potential the child will be abused again. In this article, we review the traumatic subdural hematoma as well as various morpho-structural patterns of shearing injuries and thrombosis of intracranial bridging veins. This work serves as a summary of patterns of imaging features of intracranial venous injury in AHT, as described in the literature, to facilitate familiarity and early detection of abusive head trauma in the pediatric population. Essentially, in AHT there is a traumatic injury to the bridging vein with either partial or complete tear. This can secondarily result in thrombosis at the terminal end of the bridging vein with blood clots adjacent to the bridging vein.
