Recognizing Signs of Abusive Head Trauma.
Maísa Naomi Irie1, Vinicius de Menezes Jarry1, Matheus de Lima Ruffini2
1Department of Radiology, Universidade Estadual de Campinas (Unicamp), Campinas, SP, Brazil.
Journal of Paediatrics and Child Health
|May 26, 2026
Summary
Abusive head trauma (AHT) diagnosis relies heavily on neuroimaging. Characteristic patterns on CT and MRI scans are crucial for early detection, guiding treatment, and child protection interventions.
Area of Science:
- Pediatric Radiology
- Child Abuse Forensics
- Neuroimaging
Background:
- Abusive head trauma (AHT) is a leading cause of fatal pediatric brain injury.
- Delayed diagnosis of AHT is common due to nonspecific symptoms and unreliable histories.
- Neuroimaging is essential for diagnosing AHT.
Purpose of the Study:
- To review CT and MRI findings in AHT.
- To identify imaging patterns indicative of abusive mechanisms.
- To support clinical suspicion and child protection.
Main Methods:
- Narrative review of AHT imaging features.
- Focused on retinal hemorrhages, subdural hematomas, subarachnoid/epidural hemorrhages, bridging vein thrombosis, spinal subdural hemorrhages, hypoxic-ischemic injury, parenchymal lesions, and skull fractures.
- Compared CT and MRI sensitivity.
Main Results:
- Subdural hematoma was the most frequent finding, often bilateral/asymmetric, involving high convexities, interhemispheric fissure, and posterior fossa.
- Other common findings: retinal hemorrhages, bridging vein thrombosis, spinal subdural hemorrhage, hypoxic-ischemic injury, hemispheric hypodensity, traumatic axonal injury, and complex skull fractures.
- MRI showed higher sensitivity than CT for small hemorrhages, early parenchymal injury, and axonal damage.
Conclusions:
- Recognizing neuroimaging patterns is key in suspected AHT evaluations.
- Early identification by radiologists and pediatricians is critical for acute management.
- Prompt diagnosis facilitates child protection responses, preventing recurrent injury and fatal outcomes.
