ABSTRACT
Abdominal injury in nonaccidental trauma (NAT) is an increasingly recognized cause of hospitalization in abused children. Abdominal injuries in NAT are often severe and have high rates of surgical intervention. Certain imaging findings in the pediatric abdomen, notably bowel perforation and pancreatic injury, should alert the radiologist to possible abuse and incite close interrogation concerning the reported mechanism of injury. Close inspection of the imaging study is warranted to detect additional injury sites because these injuries rarely occur in isolation. When abdominal injury is suspected in known or speculated NAT, computed tomography (CT) of the abdomen and pelvis with intravenous contrast material is recommended for diagnostic and forensic evaluation. Although the rate of bowel injury is disproportionately high in NAT, solid organs, including the liver, pancreas, and spleen, are most often injured. Adrenal and renal trauma is less frequent in NAT and is generally seen with multiple other injuries. Hypoperfusion complex is a constellation of abdominal CT findings that indicates current or impending decompensated shock and is most often due to severe neurologic impairment in NAT. Although abdominal injuries in NAT are relatively uncommon, knowledge of injury patterns and their imaging appearances is important for patient care and protection.
Subject(s)
Abdominal Injuries/diagnosis , Battered Child Syndrome/diagnosis , Child Abuse/diagnosis , Diagnostic Imaging/methods , Multiple Trauma/diagnosis , Abdominal Injuries/prevention & control , Battered Child Syndrome/prevention & control , Child , Child Abuse/prevention & control , Child, Preschool , Female , Humans , Infant , Infant, Newborn , MaleABSTRACT
Leukemic infiltrate involving the skin and subcutaneous tissue was the first manifestation of disease in a 6-month-old female infant. Knowledge of age-related distribution patterns of the red (cellular) and yellow (fatty) marrow is crucial for the interpretation of magnetic resonance imaging (MRI) studies. Diffusely decreased signal intensity throughout the bone marrow on the T1-weighted images specifically involving the epiphyseal ossification centers in infants 6 months after their appearance should be suggestive of a marrow infiltrative/replacement process. Correlation with the peripheral blood smear and bone marrow aspirate are necessary for the diagnosis of leukemia.
