Neuroimaging considerations in abusive head trauma.

This focused review on abusive head trauma describes the injuries to the head, brain and/or spine of an infant or young child from inflicted trauma and their neuroimaging correlates. Accurate recognition and diagnosis of abusive head trauma is paramount to prevent repeated injury, provide timely treatment, and ensure that accidental or underlying medical contributors have been considered. In this article, we aim to discuss the various findings on neuroimaging that have been associated with AHT, compared to those that are more consistent with accidental injuries or with underlying medical causes that may also be on the differential.

Burns in Children: Accidental or Inflicted?

This article provides a review of burns in childhood with a focus on the characteristics that help differentiate abusive from accidental burns. Case presentations are used to highlight important differences in the way that abusive versus accidental burns present to medical care.

Genital Manifestations of Physical Abuse in Male Infants and Children.

We present 3 male patients with genital bruising due to physical abuse to improve recognition of genital trauma as a sentinel injury. In the absence of an underlying medical condition or a clear acceptable accidental mechanism for the genital injury, an evaluation for child abuse is recommended.

Petechiae and subconjunctival hemorrhages in a child after a visit to the dentist.

INTRODUCTION: Subconjunctival hemorrhages and facial petechiae are rare oculo-cutaneous findings in the pediatric population and can be a sign of strangulation or traumatic asphyxia as a result of increased intrathoracic pressure. CASE PRESENTATION: A 5-year-old female presented to medical care with facial petechiae and bilateral subconjunctival hemorrhages following a routine dental appointment. The child disclosed being physically restrained and "smacked" by the dentist. While her symptoms were initially characterized as an allergic reaction by Emergency Medical Services, the child was ultimately diagnosed with traumatic asphyxia due to her extensive facial petechiae and subconjunctival hemorrhages and reported facial swelling. CONCLUSION: It is imperative for medical providers to recognize the clinical presentation of traumatic asphyxia, as non-accidental trauma should be considered in a child without a history of accidental injury. While reporting to a licensing body is not mandated in cases of child physical abuse perpetrated by health care providers, it is an important step in preventing future patient harm.

Bilateral arachnoid cyst-associated subdural fluid collections in an infant following TBI.

INTRODUCTION: arachnoid cyst-associated subdural fluid collections have been documented in children and adults following traumatic brain injury (TBI). However, this phenomenon has not been previously demonstrated in infants less than 12 months of age. We present a case of an infant with bilateral arachnoid cyst-associated subdural fluid collections identified after TBI. CASE PRESENTATION: a 9-month-old female infant with profound macrocephaly presented to medical care with altered mental status following a witnessed fall down steps while unsecured in a stroller. Neuroimaging revealed bilateral subdural fluid collections, in addition to a hyperdense subdural hematoma, that raised concern for abusive head trauma (AHT) among the pediatric inpatient team and the hospital's Suspected Child Abuse and Neglect (SCAN) Team was consulted. After excluding occult abusive injuries as well as testing for underlying medical conditions, the infant's bilateral subdural fluid collections were attributed to rupture of a pre-existing left middle cranial fossa arachnoid cyst with evidence of prior macrocephaly. CONCLUSION: In infants and toddlers, the identification of subdural fluid collections on neuroimaging warrants inclusion of AHT in the differential diagnosis. However, in infants with a history of congenital macrocephaly, and an otherwise negative AHT workup, an accidental mechanism for the formation of subdural collections should be considered, especially when co-occurring with an arachnoid cyst.