AFIP ARCHIVES - Continuing Medical Education

From the Archives of the AFIP

Child Abuse: Radiologic-Pathologic Correlation1

Published Online:Jul 1 2003https://doi.org/10.1148/rg.234035030

Abstract

In the United States, roughly one of every 100 children is subjected to some form of neglect or abuse; inflicted injury is responsible for approximately 1,200 deaths per year. Child physical abuse may manifest as virtually any injury pattern known to medicine. Some of the injuries observed in battered children are relatively unique to this population (especially when observed in infants) and therefore are highly suggestive of nonaccidental, or inflicted, injury. Worrisome injuries include rib fracture, metaphyseal fracture, interhemispheric extraaxial hemorrhage, shear-type brain injury, vertebral compression fracture, and small bowel hematoma and laceration. As noted, however, virtually any injury may be inflicted; therefore, careful consideration of the nature of the injury, the developmental capabilities of the child, and the given history are crucial to determine the likelihood that an injury was inflicted. The majority of these injuries are readily detectable at imaging, and radiologic examination forms the mainstay of evaluation of child physical abuse. Detection of metaphyseal fracture (regarded as the most specific radiographically detectable injury in abuse) depends on high-quality, small field-of-view radiographs. The injury manifests radiographically as a lucent area within the subphyseal metaphysis, extending completely or partially across the metaphysis, roughly perpendicular to the long axis of the bone. Acute rib fractures (which in infants are strongly correlated with abuse) appear as linear lucent areas. They may be difficult to discern when acute; thus, follow-up radiography increases detection of these fractures. For skull injuries, radiography is best for detecting fractures, but computed tomography and magnetic resonance imaging best depict intracranial injury.

References

1 U.S. Department of Health and Human Services Children’s Bureau (online). Child maltreatment 2000: reports from the states to the National Child Abuse and Neglect Data System. Available at: http://www.calib.com/nccanch/prevmnth/scope/ncands/cfm. Accessed February 5 2003. Google Scholar
2 MacLeod J, Nelson G. Programs for the promotion of family wellness and the prevention of child maltreatment: a meta-analytic review. Child Abuse Negl 2000; 24:1127-1149. Crossref, Medline, Google Scholar
3 Tardieu A. Etude medico-legale sur les services et mauvais traitments exerces sur des infants. Ann Hyg Publ Med Leg 1860; 13:361-398. Google Scholar
4 Caffey J. Multiple fractures in the long bones of infants suffering from chronic subdural hematoma. Am J Roentgenol Radium Ther Nucl Med 1946; 56:163-173. Medline, Google Scholar
5 Caffey J. Some traumatic lesions in growing bones other than fractures and dislocations: clinical and radiological features. Br J Radiol 1957; 30:225-238. Crossref, Medline, Google Scholar
6 Kempe CH, Silverman FN, Steele BF, Droegemueller W, Silver HK. The battered-child syndrome. JAMA 1962; 181:105-112. Google Scholar
7 Guthkelch AN. Infantile subdural haematoma and its relationship to whiplash injuries. Br Med J 1971; 2:430-431. Crossref, Medline, Google Scholar
8 Kleinman PK, Marks SC, Blackbourne B. The metaphyseal lesion in abused infants: a radiologic-histopathologic study. AJR Am J Roentgenol 1986; 146:895-905. Crossref, Medline, Google Scholar
9 Kleinman PK, Marks SC, Jr, Richmond JM, Blackbourne BD. Inflicted skeletal injury: a postmortem radiologic-histopathologic study in 31 infants. AJR Am J Roentgenol 1995; 165:647-650. Crossref, Medline, Google Scholar
10 Kleinman PK, Marks SC, Jr, Spevak MR, Belanger PL, Richmond JM. Extension of growth-plate cartilage into the metaphysis: a sign of healing fracture in abused infants. AJR Am J Roentgenol 1991; 156:775-779. Crossref, Medline, Google Scholar
11 Kleinman PK, Raptopoulos VD, Brill PW. Occult nonskeletal trauma in the battered-child syndrome. Radiology 1981; 141:393-396. Link, Google Scholar
12 Kleinman PK, Marks SC, Jr. A regional approach to the classic metaphyseal lesion in abused infants: the proximal humerus. AJR Am J Roentgenol 1996; 167:1399-1403. Crossref, Medline, Google Scholar
13 Kleinman PK, Marks SC, Jr. A regional approach to classic metaphyseal lesions in abused infants: the distal tibia. AJR Am J Roentgenol 1996; 166:1207-1212. Crossref, Medline, Google Scholar
14 Kleinman PK, Marks SC, Jr. A regional approach to the classic metaphyseal lesion in abused infants: the proximal tibia. AJR Am J Roentgenol 1996; 166:421-426. Crossref, Medline, Google Scholar
15 Kleinman PK, Marks SC, Jr. A regional approach to the classic metaphyseal lesion in abused infants: the distal femur. AJR Am J Roentgenol 1998; 170:43-47. Crossref, Medline, Google Scholar
16 Kleinman PK, Brill PW, Winchester P. Resolving duodenal-jejunal hematoma in abused children. Radiology 1986; 160:747-750. Link, Google Scholar
17 Kleinman PK, Marks SC. Vertebral body fractures in child abuse: radiologic-histopathologic correlates. Invest Radiol 1992; 27:715-722. Crossref, Medline, Google Scholar
18 Herndon WA. Child abuse in a military population. J Pediatr Orthop 1983; 3:73-76. Crossref, Medline, Google Scholar
19 Akbarnia B, Torg JS, Kirkpatrick J, Sussman S. Manifestations of the battered-child syndrome. J Bone Joint Surg Am 1974; 56:1159-1166. Crossref, Medline, Google Scholar
20 Ebbin AJ, Gollub MH, Stein AM, Wilson MG. Battered child syndrome at the Los Angeles County General Hospital. Am J Dis Child 1969; 118:660-667. Medline, Google Scholar
21 King J, Diefendorf D, Apthorp J, Negrete VF, Carlson M. Analysis of 429 fractures in 189 battered children. J Pediatr Orthop 1988; 8:585-589. Medline, Google Scholar
22 Worlock P, Stower M, Barbor P. Patterns of fractures in accidental and non-accidental injury in children: a comparative study. Br Med J (Clin Res Ed) 1986; 293:100-102. Crossref, Medline, Google Scholar
23 Alexander CJ. Effect of growth rate on the strength of the growth plate shaft junction. Skeletal Radiol 1976; 1:67-76. Crossref, Google Scholar
24 Merten DF, Radkowski MA, Leonidas JC. The abused child: a radiological reappraisal. Radiology 1983; 146:377-381. Link, Google Scholar
25 Loder RT, Bookout C. Fracture patterns in battered children. J Orthop Trauma 1991; 5:428-433. Crossref, Medline, Google Scholar
26 DeLee JC, Wilkins KE, Rogers LF, Rockwood CA. Fracture-separation of the distal humeral epiphysis. J Bone Joint Surg Am 1980; 62:46-51. Crossref, Medline, Google Scholar
27 Maresh MM. Linear growth of long bones of extremities from infancy through adolescence. Am J Dis Child 1955; 89:725-742. Google Scholar
28 Trueta J, Amato VP. The vascular contribution to osteogenesis. III. Changes in the growth cartilage caused by experimentally induced ischaemia. J Bone Joint Surg Br 1960; 42:571-587. Google Scholar
29 Osier LK, Marks SC, Jr, Kleinman PK. Metaphyseal extensions of hypertrophied chondrocytes in abused infants indicate healing fractures. J Pediatr Orthop 1993; 13:249-254. Medline, Google Scholar
30 Conway JJ, Collins M, Tanz RR, et al. The role of bone scintigraphy in detecting child abuse. Semin Nucl Med 1993; 23:321-333. Crossref, Medline, Google Scholar
31 American Academy of Pediatrics Section on Radiology. Diagnostic imaging of child abuse. Pediatrics 2000; 105:1345-1348. Crossref, Medline, Google Scholar
32 Thomas PS. Rib fractures in infancy. Ann Radiol (Paris) 1977; 20:115-122. Medline, Google Scholar
33 Garcia VF, Gottschall CS, Eichelberger MR, Bowman LM. Rib fractures in children: a marker of severe trauma. J Trauma 1990; 30:695-700. Crossref, Medline, Google Scholar
34 Feldman KW, Brewer DK. Child abuse, cardiopulmonary resuscitation, and rib fractures. Pediatrics 1984; 73:339-342. Crossref, Medline, Google Scholar
35 Kleinman PK. Bony thoracic trauma. In: Kleinman PK, eds. Diagnostic imaging of child abuse. 2nd ed. St Louis, Mo: Mosby, 1998; 110-111. Google Scholar
36 Ng CS, Hall CM. Costochondral junction fractures and intra-abdominal trauma in non-accidental injury (child abuse). Pediatr Radiol 1998; 28:671-676. Crossref, Medline, Google Scholar
37 Strouse PJ, Owings CL. Fractures of the first rib in child abuse. Radiology 1995; 197:763-765. Link, Google Scholar
38 Hartmann RW, Jr. Radiological case of the month. Rib fractures produced by birth trauma. Arch Pediatr Adolesc Med 1997; 151:947-948. Google Scholar
39 Rizzolo PJ, Coleman PR. Neonatal rib fracture: birth trauma or child abuse? J Fam Pract 1989; 29:561-563. Medline, Google Scholar
40 Bhat BV, Kumar A, Oumachigui A. Bone injuries during delivery. Indian J Pediatr 1994; 61:401-405. Crossref, Medline, Google Scholar
41 Kleinman PK, Marks SC, Adams VI, Blackbourne BD. Factors affecting visualization of posterior rib fractures in abused infants. AJR Am J Roentgenol 1988; 150:635-638. Crossref, Medline, Google Scholar
42 Kleinman PK, Marks SC, Spevak MR, Richmond JM. Fractures of the rib head in abused infants. Radiology 1992; 185:119-123. Link, Google Scholar
43 Kleinman PK, Schlesinger AE. Mechanical factors associated with posterior rib fractures: laboratory and case studies. Pediatr Radiol 1997; 27:87-91. Crossref, Medline, Google Scholar
44 Kleinman PK, Marks SC, Jr, Nimkin K, Rayder SM, Kessler SC. Rib fractures in 31 abused infants: postmortem radiologic-histopathologic study. Radiology 1996; 200:807-810. Link, Google Scholar
45 Potts WJ. The role of the hematoma in fracture healing. Surg Gynecol Obstet 1933; 57:318-324. Google Scholar
46 Ham AW. A histological study of the early phases of bone repair. J Bone Joint Surg Am 1930; 12:827-844. Google Scholar
47 Cruess RL, Dumont J. Fracture healing. Can J Surg 1975; 18:403-413. Medline, Google Scholar
48 Frost HM. The biology of fracture healing: an overview for clinicians—part I. Clin Orthop 1989; Nov:283-293. Google Scholar
49 Frost HM. The biology of fracture healing: an overview for clinicians—part II. Clin Orthop 1989; Nov:294-309. Google Scholar
50 Kleinman PK, Nimkin K, Spevak MR, et al. Follow-up skeletal surveys in suspected child abuse. AJR Am J Roentgenol 1996; 167:893-896. Crossref, Medline, Google Scholar
51 Sty JR, Starshak RJ. The role of bone scintigraphy in the evaluation of the suspected abused child. Radiology 1983; 146:369-375. Link, Google Scholar
52 Smith FW, Gilday DL, Ash JM, Green MD. Unsuspected costo-vertebral fractures demonstrated by bone scanning in the child abuse syndrome. Pediatr Radiol 1980; 10:103-106. Crossref, Medline, Google Scholar
53 Haase GM, Ortiz VN, Sfakianakis GN, Morse TS. The value of radionuclide bone scanning in the early recognition of deliberate child abuse. J Trauma 1980; 20:873-875. Crossref, Medline, Google Scholar
54 Kleinman PK. Bony thoracic trauma. In: Kleinman PK, eds. Diagnostic imaging of child abuse. 2nd ed. St Louis, Mo: Mosby, 1998; 132. Google Scholar
55 Patterson RH, Burns WA, Jannotta FS. Complications of external cardiac resuscitation: a retrospective review and survey of the literature. Med Ann Dist Columbia 1974; 43:389-394. Medline, Google Scholar
56 Feldman KW, Brewer DK. Child abuse, cardiopulmonary resuscitation, and rib fractures. Pediatrics 1984; 73:339-342. Crossref, Medline, Google Scholar
57 Bush CM, Jones JS, Cohle SD, Johnson H. Pediatric injuries from cardiopulmonary resuscitation. Ann Emerg Med 1996; 28:40-44. Crossref, Medline, Google Scholar
58 Spevak MR, Kleinman PK, Belanger PL, Primack C, Richmond JM. Cardiopulmonary resuscitation and rib fractures in infants: a postmortem radiologic-pathologic study. JAMA 1994; 272:617-618. Crossref, Medline, Google Scholar
59 Betz P, Liebhardt E. Rib fractures in children: resuscitation or child abuse? Int J Legal Med 1994; 106:215-218. Crossref, Medline, Google Scholar
60 Cumming WA. Neonatal skeletal fractures: birth trauma or child abuse? J Can Assoc Radiol 1979; 30:30-33. Medline, Google Scholar
61 Islam O, Soboleski D, Symons S, Davidson LK, Ashworth MA, Babyn P. Development and duration of radiographic signs of bone healing in children. AJR Am J Roentgenol 2000; 175:75-78. Crossref, Medline, Google Scholar
62 Helfer RE, Slovis TL, Black M. Injuries resulting when small children fall out of bed. Pediatrics 1977; 60:533-535. Crossref, Medline, Google Scholar
63 Nimityongskul P, Anderson LD. The likelihood of injuries when children fall out of bed. J Pediatr Orthop 1987; 7:184-186. Crossref, Medline, Google Scholar
64 Lyons TJ, Oates RK. Falling out of bed: a relatively benign occurrence. Pediatrics 1993; 92:125-127. Medline, Google Scholar
65 Joffe M, Ludwig S. Stairway injuries in children. Pediatrics 1988; 82:457-461. Crossref, Medline, Google Scholar
66 Bertocci GE, Pierce MC, Deemer E, Aguel F. Computer simulation of stair falls to investigate scenarios in child abuse. Arch Pediatr Adolesc Med 2001; 155:1008-1014. Crossref, Medline, Google Scholar
67 Chiaviello CT, Christoph RA, Bond GR. Stairway-related injuries in children. Pediatrics 1994; 94:679-681. Medline, Google Scholar
68 Huntimer CM, Muret-Wagstaff S, Leland NL. Can falls on stairs result in small intestine perforations? Pediatrics 2000; 106:301-305. Crossref, Medline, Google Scholar
69 Injuries associated with infant walkers.Pediatrics2001; 108:790-792. Crossref, Medline, Google Scholar
70 Gross RH, Davidson R, Sullivan JA, Peeples RE, Hufft R. Cast brace management of the femoral shaft fracture in children and young adults. J Pediatr Orthop 1983; 3:572-582. Crossref, Medline, Google Scholar
71 Thomas SA, Rosenfield NS, Leventhal JM, Markowitz RI. Long-bone fractures in young children: distinguishing accidental injuries from child abuse. Pediatrics 1991; 88:471-476. Crossref, Medline, Google Scholar
72 Swischuk LE. Spine and spinal cord trauma in the battered child syndrome. Radiology 1969; 92:733-738. Link, Google Scholar
73 Kleinman PK, Zito JL. Avulsion of the spinous processes caused by infant abuse. Radiology 1984; 151:389-391. Link, Google Scholar
74 Kleinman PK, Blackbourne BD, Marks SC, Karellas A, Belanger PL. Radiologic contributions to the investigation and prosecution of cases of fatal infant abuse. N Engl J Med 1989; 320:507-511. Crossref, Medline, Google Scholar
75 Bruce DA, Zimmerman RA. Shaken impact syndrome. Pediatr Ann 1989; 18:482-484, 486–489, 492–494. Crossref, Medline, Google Scholar
76 Billmire ME, Myers PA. Serious head injury in infants: accident or abuse? Pediatrics 1985; 75:340-342. Crossref, Medline, Google Scholar
77 Duhaime AC, Alario AJ, Lewander WJ, et al. Head injury in very young children: mechanisms, injury types, and ophthalmologic findings in 100 hospitalized patients younger than 2 years of age. Pediatrics 1992; 90:179-185. Crossref, Medline, Google Scholar
78 Ludwig S, Warman M. Shaken baby syndrome: a review of 20 cases. Ann Emerg Med 1984; 13:104-107. Crossref, Medline, Google Scholar
79 Alexander RC, Schor DP, Smith WL, Jr. Magnetic resonance imaging of intracranial injuries from child abuse. J Pediatr 1986; 109:975-979. Crossref, Medline, Google Scholar
80 Conway EE, Jr. Nonaccidental head injury in infants: “the shaken baby syndrome revisited”. Pediatr Ann 1998; 27:677-690. Crossref, Medline, Google Scholar
81 Duhaime AC, Christian C, Moss E, Seidl T. Long-term outcome in infants with the shaking-impact syndrome. Pediatr Neurosurg 1996; 24:292-298. Crossref, Medline, Google Scholar
82 Zimmerman RA, Bilaniuk LT, Bruce D, Schut L, Uzzell B, Goldberg HI. Computed tomography of craniocerebral injury in the abused child. Radiology 1979; 130:687-690. Link, Google Scholar
83 Tsai FY, Zee CS, Apthorp JS, Dixon GH. Computed tomography in child abuse head trauma. J Comput Tomogr 1980; 4:277-286. Crossref, Medline, Google Scholar
84 Merten DF, Osborne DR, Radkowski MA, Leonidas JC. Craniocerebral trauma in the child abuse syndrome: radiological observations. Pediatr Radiol 1984; 14:272-277. Crossref, Medline, Google Scholar
85 O’Neill JA, Jr, Meacham WF, Griffin JP, Sawyers JL. Patterns of injury in the battered child syndrome. J Trauma 1973; 13:332-339. Crossref, Medline, Google Scholar
86 Cohen RA, Kaufman RA, Myers PA, Towbin RB. Cranial computed tomography in the abused child with head injury. AJR Am J Roentgenol 1986; 146:97-102. Crossref, Medline, Google Scholar
87 Williams RA. Injuries in infants and small children resulting from witnessed and corroborated free falls. J Trauma 1991; 31:1350-1352. Crossref, Medline, Google Scholar
88 Tarantino CA, Dowd MD, Murdock TC. Short vertical falls in infants. Pediatr Emerg Care 1999; 15:5-8. Crossref, Medline, Google Scholar
89 Claydon SM. Fatal extradural hemorrhage following a fall from a baby bouncer. Pediatr Emerg Care 1996; 12:432-434. Crossref, Medline, Google Scholar
90 Selbst SM, Baker MD, Shames M. Bunk bed injuries. Am J Dis Child 1990; 144:721-723. Medline, Google Scholar
91 Mayr JM, Seebacher U, Lawrenz K, Pesendorfer P, Berghold A, Baradaran S. Bunk beds: a still underestimated risk for accidents in childhood? Eur J Pediatr 2000; 159:440-443. Crossref, Medline, Google Scholar
92 Kleinman PK, Spevak MR. Soft tissue swelling and acute skull fractures. J Pediatr 1992; 121:737-739. Crossref, Medline, Google Scholar
93 Block RW. Child abuse: controversies and imposters. Curr Probl Pediatr 1999; 29:249-272. Medline, Google Scholar
94 Barnes PD, Robson CD. CT findings in hyperacute nonaccidental brain injury. Pediatr Radiol 2000; 30:74-81. Crossref, Medline, Google Scholar
95 Meservy CJ, Towbin R, McLaurin RL, Myers PA, Ball W. Radiographic characteristics of skull fractures resulting from child abuse. AJR Am J Roentgenol 1987; 149:173-175. Crossref, Medline, Google Scholar
96 Hobbs CJ. Skull fracture and the diagnosis of abuse. Arch Dis Child 1984; 59:246-252. Crossref, Medline, Google Scholar
97 Saulsbury FT, Alford BA. Intracranial bleeding from child abuse: the value of skull radiographs. Pediatr Radiol 1982; 12:175-178. Crossref, Medline, Google Scholar
98 Nimkin K, Kleinman PK. Imaging of child abuse. Radiol Clin North Am 2001; 39:843-864. Crossref, Medline, Google Scholar
99 Shugerman RP, Paez A, Grossman DC, Feldman KW, Grady MS. Epidural hemorrhage: is it abuse? Pediatrics 1996; 97:664-668. Crossref, Medline, Google Scholar
100 Reece RM, Sege R. Childhood head injuries: accidental or inflicted? Arch Pediatr Adolesc Med 2000; 154:11-15. Medline, Google Scholar
101 Dashti SR, Decker DD, Razzaq A, Cohen AR. Current patterns of inflicted head injury in children. Pediatr Neurosurg 1999; 31:302-306. Crossref, Medline, Google Scholar
102 Holden KR, Titus MO, Van Tassel P. Cranial magnetic resonance imaging examination of normal term neonates: a pilot study. J Child Neurol 1999; 14:708-710. Crossref, Medline, Google Scholar
103 Zimmerman RA, Tavani F, Mahle WS, Clancy RR. Incidence of subdural hemorrhage by MR in term neonates with congenital heart disease undergoing vaginal delivery. Presented at the 45th Annual Meeting of the Society for Pediatric Radiology, Philadelphia, April 28–May 1 2002. Google Scholar
104 Zimmerman RA, Bilaniuk LT. Pediatric head trauma. Neuroimaging Clin N Am 1994; 4:349-366. Medline, Google Scholar
105 Sato Y, Yuh WT, Smith WL, Alexander RC, Kao SC, Ellerbroek CJ. Head injury in child abuse: evaluation with MR imaging. Radiology 1989; 173:653-657. Link, Google Scholar
106 Zimmerman RA, Bilaniuk LT, Bruce D, Schut L, Uzzell B, Goldberg HI. Interhemispheric acute subdural hematoma: a computed tomographic manifestation of child abuse by shaking. Neuroradiology 1978; 16:39-40. Crossref, Medline, Google Scholar
107 Zimmerman RD, Russell EJ, Yurberg E, Leeds NE. Falx and interhemispheric fissure on axial CT. II. Recognition and differentiation of interhemispheric subarachnoid and subdural hemorrhage. AJNR Am J Neuroradiol 1982; 3:635-642. Google Scholar
108 Ommaya AK, Yarnell P. Subdural haematoma after whiplash injury. Lancet 1969; 2:237-239. Medline, Google Scholar
109 Chen JC, Levy ML. Causes, epidemiology, and risk factors of chronic subdural hematoma. Neurosurg Clin N Am 2000; 11:399-406. Crossref, Medline, Google Scholar
110 Maxeiner H. Demonstration and interpretation of bridging vein ruptures in cases of infantile subdural bleedings. J Forensic Sci 2001; 46:85-93. Medline, Google Scholar
111 Friede RL, Schachenmayr W. The origin of subdural neomembranes. II. Fine structural of neomembranes. Am J Pathol 1978; 92:69-84. Google Scholar
112 Frederickson RG. The subdural space interpreted as a cellular layer of meninges. Anat Rec 1991; 230:38-51. Crossref, Medline, Google Scholar
113 Killeffer JA, Killeffer FA, Schochet SS. The outer neomembrane of chronic subdural hematoma. Neurosurg Clin N Am 2000; 11:407-412. Crossref, Medline, Google Scholar
114 Yamashima T, Friede RL. Why do bridging veins rupture into the virtual subdural space? J Neurol Neurosurg Psychiatry 1984; 47:121-127. Crossref, Medline, Google Scholar
115 Schachenmayr W, Friede RL. The origin of subdural neomembranes. I. Fine structure of the dura-arachnoid interface in man. Am J Pathol 1978; 92:53-68. Google Scholar
116 Yamashima T. The inner membrane of chronic subdural hematomas: pathology and pathophysiology. Neurosurg Clin N Am 2000; 11:413-424. Crossref, Medline, Google Scholar
117 Duhaime AC, Christian CW, Rorke LB, Zimmerman RA. Nonaccidental head injury in infants: the “shaken-baby syndrome”. N Engl J Med 1998; 338:1822-1829. Crossref, Medline, Google Scholar
118 Case ME, Graham MA, Handy TC, Jentzen JM, Monteleone JA. Position paper on fatal abusive head injuries in infants and young children. Am J Forensic Med Pathol 2001; 22:112-122. Crossref, Medline, Google Scholar
119 Ikeda K, Ito H, Yamashita J. Relation of regional cerebral blood flow to hemiparesis in chronic subdural hematoma. Surg Neurol 1990; 33:87-95. Crossref, Medline, Google Scholar
120 Munro DM. Surgical pathology of subdural hematoma: based on a study of one hundred and five cases. Arch Neurol Psychol 1936; 35:64-78. Crossref, Google Scholar
121 Sato S, Suzuki J. Ultrastructural observations of the capsule of chronic subdural hematoma in various clinical stages. J Neurosurg 1975; 43:569-578. Crossref, Medline, Google Scholar
122 Suzuki K, Sugita K, Akai T, Takahata T, Sonobe M, Takahashi S. Treatment of chronic subdural hematoma by closed-system drainage without irrigation. Surg Neurol 1998; 50:231-234. Crossref, Medline, Google Scholar
123 Yamashima T, Yamamoto S, Friede RL. The role of endothelial gap junctions in the enlargement of chronic subdural hematomas. J Neurosurg 1983; 59:298-303. Crossref, Medline, Google Scholar
124 Murakami H, Hirose Y, Sagoh M, et al. Why do chronic subdural hematomas continue to grow slowly and not coagulate? Role of thrombomodulin in the mechanism. J Neurosurg 2002; 96:877-884. Google Scholar
125 Ito H, Komai T, Yamamoto S. Fibrinolytic enzyme in the lining walls of chronic subdural hematoma. J Neurosurg 1978; 48:197-200. Crossref, Medline, Google Scholar
126 Lim DJ, Chung YG, Park YK, et al. Relationship between tissue plasminogen activator, plasminogen activator inhibitor and CT image in chronic subdural hematoma. J Korean Med Sci 1995; 10:373-378. Crossref, Medline, Google Scholar
127 Hardman JM. The pathology of traumatic brain injuries. Adv Neurol 1979; 22:15-50. Medline, Google Scholar
128 Bergstrom M, Ericson K, Levander B, Svendsen P. Computed tomography of cranial subdural and epidural hematomas: variation of attenuation related to time and clinical events such as rebleeding. J Comput Assist Tomogr 1977; 1:449-455. Crossref, Medline, Google Scholar
129 Lee KS, Bae WK, Bae HG, Doh JW, Yun IG. The computed tomographic attenuation and the age of subdural hematomas. J Korean Med Sci 1997; 12:353-359. Crossref, Medline, Google Scholar
130 Dias MS, Backstrom J, Falk M, Li V. Serial radiography in the infant shaken impact syndrome. Pediatr Neurosurg 1998; 29:77-85. Crossref, Medline, Google Scholar
131 Kao MC. Sedimentation level in chronic subdural hematoma visible on computerized tomography. J Neurosurg 1983; 58:246-251. Crossref, Medline, Google Scholar
132 Scotti G, Terbrugge K, Melancon D, Belanger G. Evaluation of the age of subdural hematomas by computerized tomography. J Neurosurg 1977; 47:311-315. Crossref, Medline, Google Scholar
133 Firsching R, Frowein RA, Thun F. Encapsulated subdural hematoma. Neurosurg Rev 1989; 12(suppl 1):207-214. Crossref, Medline, Google Scholar
134 Sargent S, Kennedy JG, Kaplan JA. “Hyperacute” subdural hematoma: CT mimic of recurrent episodes of bleeding in the setting of child abuse. J Forensic Sci 1996; 41:314-316. Medline, Google Scholar
135 Greenberg J, Cohen WA, Cooper PR. The “hyperacute” extraaxial intracranial hematoma: computed tomographic findings and clinical significance. Neurosurgery 1985; 17:48-56. Crossref, Medline, Google Scholar
136 Ikeda A, Sato O, Tsugane R, Shibuya N, Yamamoto I, Shimoda M. Infantile acute subdural hematoma. Childs Nerv Syst 1987; 3:19-22. Crossref, Medline, Google Scholar
137 Bradley WG, Jr. MR appearance of hemorrhage in the brain. Radiology 1993; 189:15-26. Link, Google Scholar
138 Kleinman PK, Ragland RL. Gadopentetate dimeglumine-enhanced MR imaging of subdural hematoma in an abused infant. AJR Am J Roentgenol 1996; 166:1456-1458. Crossref, Medline, Google Scholar
139 Chen CY, Huang CC, Zimmerman RA, et al. High-resolution cranial ultrasound in the shaken-baby syndrome. Neuroradiology 2001; 43:653-661. Crossref, Medline, Google Scholar
140 Kleinman PK, Barnes PD. Head trauma. In: Kleinman PK, eds. Diagnostic imaging of child abuse. 2nd ed. St Louis, Mo: Mosby, 1998; 306-307. Google Scholar
141 Krous HF, Byard RW. Shaken infant syndrome: selected controversies. Pediatr Dev Pathol 1999; 2:497-498. Crossref, Medline, Google Scholar
142 Kirschner RH. The pathology of child abuse. In: Helfer ME, Kempe RS, Krugman RD, eds. The battered child. 5th ed. Chicago, Ill: University of Chicago Press, 1998; 271-274. Google Scholar
143 Holbourn AH. Mechanics of head injuries. Lancet 1943; 2:438-441. Google Scholar
144 Holbourn AH. The mechanics of brain injury. Br Med Bull 1945; 3:147-149. Crossref, Google Scholar
145 Calder IM, Hill I, Scholtz CL. Primary brain trauma in non-accidental injury. J Clin Pathol 1984; 37:1095-1100. Crossref, Medline, Google Scholar
146 Vowles GH, Scholtz CL, Cameron JM. Diffuse axonal injury in early infancy. J Clin Pathol 1987; 40:185-189. Crossref, Medline, Google Scholar
147 Lindenberg R, Freytag E. Morphology of brain lesions from blunt trauma in early infancy. Arch Pathol 1969; 87:298-305. Medline, Google Scholar
148 Adams JH, Graham DI, Murray LS, Scott G. Diffuse axonal injury due to nonmissile head injury in humans: an analysis of 45 cases. Ann Neurol 1982; 12:557-563. Crossref, Medline, Google Scholar
149 Shannon P, Smith CR, Deck J, Ang LC, Ho M, Becker L. Axonal injury and the neuropathology of shaken baby syndrome. Acta Neuropathol (Berl) 1998; 95:625-631. Crossref, Medline, Google Scholar
150 McKenzie KJ, McLellan DR, Gentleman SM, Maxwell WL, Gennarelli TA, Graham DI. Is beta-APP a marker of axonal damage in short-surviving head injury? Acta Neuropathol (Berl) 1996; 92:608-613. Crossref, Medline, Google Scholar
151 Gentleman SM, Nash MJ, Sweeting CJ, Graham DI, Roberts GW. Beta-amyloid precursor protein (beta APP) as a marker for axonal injury after head injury. Neurosci Lett 1993; 160:139-144. Crossref, Medline, Google Scholar
152 Kaur B, Rutty GN, Timperley WR. The possible role of hypoxia in the formation of axonal bulbs. J Clin Pathol 1999; 52:203-209. Crossref, Medline, Google Scholar
153 Geddes JF, Hackshaw AK, Vowles GH, Nickols CD, Whitwell HL. Neuropathology of inflicted head injury in children. I. Patterns of brain damage. Brain 2001; 124:1290-1298. Google Scholar
154 Geddes JF, Vowles GH, Hackshaw AK, Nickols CD, Scott IS, Whitwell HL. Neuropathology of inflicted head injury in children. II. Microscopic brain injury in infants. Brain 2001; 124:1299-1306. Google Scholar
155 Johnson DL, Boal D, Baule R. Role of apnea in nonaccidental head injury. Pediatr Neurosurg 1995; 23:305-310. Crossref, Medline, Google Scholar
156 Auer RN. Hypoxia and related conditions London, England: Arnold, 2002. Google Scholar
157 Kleinman PK, Barnes PD. Head trauma. In: Kleinman PK, eds. Diagnostic imaging of child abuse. 2nd ed. St Louis, Mo: Mosby, 1998; 316. Google Scholar
158 Kleinman PK, Barnes PD. Head trauma. In: Kleinman PK, eds. Diagnostic imaging of child abuse. 2nd ed. St Louis, Mo: Mosby, 1998; 317. Google Scholar
159 Jaspan T, Narborough G, Punt JA, Lowe J. Cerebral contusional tears as a marker of child abuse: detection by cranial sonography. Pediatr Radiol 1992; 22:237-245. Crossref, Medline, Google Scholar
160 Duhaime AC, Gennarelli TA, Thibault LE, Bruce DA, Margulies SS, Wiser R. The shaken baby syndrome: a clinical, pathological, and biomechanical study. J Neurosurg 1987; 66:409-415. Crossref, Medline, Google Scholar
161 Kleinman PK, Barnes PD. Head trauma. In: Kleinman PK, eds. Diagnostic imaging of child abuse. 2nd ed. St Louis, Mo: Mosby, 1998; 315. Google Scholar
162 Chen CY, Zimmerman RA, Rorke LB. Neuroimaging in child abuse: a mechanism-based approach. Neuroradiology 1999; 41:711-722. Crossref, Medline, Google Scholar
163 Hadley MN, Sonntag VK, Rekate HL, Murphy A. The infant whiplash-shake injury syndrome: a clinical and pathological study. Neurosurgery 1989; 24:536-540. Crossref, Medline, Google Scholar
164 Gleckman AM, Bell MD, Evans RJ, Smith TW. Diffuse axonal injury in infants with nonaccidental craniocerebral trauma: enhanced detection by beta-amyloid precursor protein immunohistochemical staining. Arch Pathol Lab Med 1999; 123:146-151. Crossref, Medline, Google Scholar
165 Geddes JF, Whitwell HL, Graham DI. Traumatic axonal injury: practical issues for diagnosis in medicolegal cases. Neuropathol Appl Neurobiol 2000; 26:105-116. Crossref, Medline, Google Scholar
166 Suh DY, Davis PC, Hopkins KL, Fajman NN, Mapstone TB. Nonaccidental pediatric head injury: diffusion-weighted imaging findings. Neurosurgery 2001; 49:309-318; discussion 318–320. Crossref, Medline, Google Scholar
167 Biousse V, Suh DY, Newman NJ, Davis PC, Mapstone T, Lambert SR. Diffusion-weighted magnetic resonance imaging in shaken baby syndrome. Am J Ophthalmol 2002; 133:249-255. Crossref, Medline, Google Scholar
168 Han BK, Towbin RB, De Courten-Myers G, McLaurin RL, Ball WS, Jr. Reversal sign on CT: effect of anoxic/ischemic cerebral injury in children. AJR Am J Roentgenol 1990; 154:361-368. Crossref, Medline, Google Scholar
169 Harwood-Nash DC. Abuse to the pediatric central nervous system. AJNR Am J Neuroradiol 1992; 13:569-575. Medline, Google Scholar
170 Schaefer PW, Grant PE, Gonzalez RG. Diffusion-weighted MR imaging of the brain. Radiology 2000; 217:331-345. Link, Google Scholar
171 Liu AY, Maldjian JA, Bagley LJ, Sinson GP, Grossman RI. Traumatic brain injury: diffusion-weighted MR imaging findings. AJNR Am J Neuroradiol 1999; 20:1636-1641. Medline, Google Scholar
172 Ommaya AK, Faas F, Yarnell P. Whiplash injury and brain damage: an experimental study. JAMA 1968; 204:285-289. Crossref, Medline, Google Scholar
173 Caffey J. The whiplash shaken infant syndrome: manual shaking by the extremities with whiplash-induced intracranial and intraocular bleedings, linked with residual permanent brain damage and mental retardation. Pediatrics 1974; 54:396-403. Crossref, Medline, Google Scholar
174 Ommaya AK, Goldsmith W, Thibault L. Biomechanics and neuropathology of adult and paediatric head injury. Br J Neurosurg 2002; 16:220-242. Crossref, Medline, Google Scholar
175 Zhang L, Yang KH, King AI. Biomechanics of neurotrauma. Neurol Res 2001; 23:144-156. Crossref, Medline, Google Scholar
176 Gilliland MG, Luckenbach MW, Chenier TC. Systemic and ocular findings in 169 prospectively studied child deaths: retinal hemorrhages usually mean child abuse. Forensic Sci Int 1994; 68:117-132. Crossref, Medline, Google Scholar
177 Morad Y, Kim YM, Armstrong DC, Huyer D, Mian M, Levin AV. Correlation between retinal abnormalities and intracranial abnormalities in the shaken baby syndrome. Am J Ophthalmol 2002; 134:354-359. Crossref, Medline, Google Scholar
178 Alexander R, Sato Y, Smith W, Bennett T. Incidence of impact trauma with cranial injuries ascribed to shaking. Am J Dis Child 1990; 144:724-726. Medline, Google Scholar
179 Gilliland MG, Folberg R. Shaken babies: some have no impact injuries. J Forensic Sci 1996; 41:114-116. Medline, Google Scholar
180 Pounder DJ. Shaken adult syndrome. Am J Forensic Med Pathol 1997; 18:321-324. Crossref, Medline, Google Scholar
181 Elder JE, Taylor RG, Klug GL. Retinal haemorrhage in accidental head trauma in childhood. J Paediatr Child Health 1991; 27:286-289. Crossref, Medline, Google Scholar
182 Ewing-Cobbs L, Prasad M, Kramer L, et al. Acute neuroradiologic findings in young children with inflicted or noninflicted traumatic brain injury. Childs Nerv Syst 2000; 16:25-33. Crossref, Medline, Google Scholar
183 DiScala C, Sege R, Li G, Reece RM. Child abuse and unintentional injuries: a 10-year retrospective. Arch Pediatr Adolesc Med 2000; 154:16-22. Medline, Google Scholar
184 Kivlin JD, Simons KB, Lazoritz S, Ruttum MS. Shaken baby syndrome. Ophthalmology 2000; 107:1246-1254. Crossref, Medline, Google Scholar
185 Feldman KW, Weinberger E, Milstein JM, Fligner CL. Cervical spine MRI in abused infants. Child Abuse Negl 1997; 21:199-205. Crossref, Medline, Google Scholar
186 Kirks DR. Radiological evaluation of visceral injuries in the battered child syndrome. Pediatr Ann 1983; 12:888-893. Crossref, Medline, Google Scholar
187 Ng CS, Hall CM, Shaw DG. The range of visceral manifestations of non-accidental injury. Arch Dis Child 1997; 77:167-174. Crossref, Medline, Google Scholar
188 Sivit CJ, Taylor GA, Eichelberger MR. Visceral injury in battered children: a changing perspective. Radiology 1989; 173:659-661. Link, Google Scholar
189 Cooper A, Floyd T, Barlow B, et al. Major blunt abdominal trauma due to child abuse. J Trauma 1988; 28:1483-1487. Crossref, Medline, Google Scholar
190 Ledbetter DJ, Hatch EI, Jr, Feldman KW, Fligner CL, Tapper D. Diagnostic and surgical implications of child abuse. Arch Surg 1988; 123:1101-1105. Crossref, Medline, Google Scholar
191 Touloukian RJ. Abdominal visceral injuries in battered children. Pediatrics 1968; 42:642-646. Crossref, Medline, Google Scholar
192 McCort J, Vaudagna J. Visceral injuries in battered children. Radiology 1964; 82:424-428. Link, Google Scholar
193 Woolley MM, Mahour GH, Sloan T. Duodenal hematoma in infancy and childhood: changing etiology and changing treatment. Am J Surg 1978; 136:8-14. Crossref, Medline, Google Scholar
194 Fossum RM, Descheneaux KA. Blunt trauma of the abdomen in children. J Forensic Sci 1991; 36:47-50. Medline, Google Scholar
195 Kunin JR, Korobkin M, Ellis JH, Francis IR, Kane NM, Siegel SE. Duodenal injuries caused by blunt abdominal trauma: value of CT in differentiating perforation from hematoma. AJR Am J Roentgenol 1993; 160:1221-1223. Crossref, Medline, Google Scholar
196 Sivit CJ, Eichelberger MR, Taylor GA. CT in children with rupture of the bowel caused by blunt trauma: diagnostic efficacy and comparison with hypoperfusion complex. AJR Am J Roentgenol 1994; 163:1195-1198. Crossref, Medline, Google Scholar
197 Radkowski MA. The battered child syndrome: pitfalls in radiological diagnosis. Pediatr Ann 1983; 12:894-903. Crossref, Medline, Google Scholar
198 Hernanz-Schulman M, Genieser NB, Ambrosino M. Sonographic diagnosis of intramural duodenal hematoma. J Ultrasound Med 1989; 8:273-276. Crossref, Medline, Google Scholar
199 Cooney DR, Crosfeld JL. Operative management of pancreatic pseudocysts in infants and children: a review of 75 cases. Ann Surg 1975; 182:590-596. Crossref, Medline, Google Scholar
200 Ziegler DW, Long JA, Philippart AI, Klein MD. Pancreatitis in childhood: experience with 49 patients. Ann Surg 1988; 207:257-261. Crossref, Medline, Google Scholar
201 Slovis TL, Berdon WE, Haller JO, Baker DH, Rosen L. Pancreatitis and the battered child syndrome: report of 2 cases with skeletal involvement. Am J Roentgenol Radium Ther Nucl Med 1975; 125:456-461. Crossref, Medline, Google Scholar
202 Slovis TL, VonBerg VJ, Mikelic V. Sonography in the diagnosis and management of pancreatic pseudocysts and effusions in childhood. Radiology 1980; 135:153-155. Link, Google Scholar
203 Herman TE, Siegel MJ. CT of the pancreas in children. AJR Am J Roentgenol 1991; 157:375-379. Crossref, Medline, Google Scholar
204 King LR, Siegel MJ, Balfe DM. Acute pancreatitis in children: CT findings of intra- and extrapancreatic fluid collections. Radiology 1995; 195:196-200. Link, Google Scholar
205 Hilfer CL, Holgersen LO. Massive chylous ascites and transected pancreas secondary to child abuse: successful non-surgical management. Pediatr Radiol 1995; 25:117-119. Crossref, Medline, Google Scholar
206 Case ME, Nanduri R. Laceration of the stomach by blunt trauma in a child: a case of child abuse. J Forensic Sci 1983; 28:496-501. Medline, Google Scholar
207 Nimkin K, Teeger S, Wallach MT, DuVally JC, Spevak MR, Kleinman PK. Adrenal hemorrhage in abused children: imaging and postmortem findings. AJR Am J Roentgenol 1994; 162:661-663. Crossref, Medline, Google Scholar
208 Halsted CC, Shapiro SR. Child abuse: acute renal failure from ruptured bladder. Am J Dis Child 1979; 133:861-862. Medline, Google Scholar
209 Ablin DS, Reinhart MA. Esophageal perforation with mediastinal abscess in child abuse. Pediatr Radiol 1990; 20:524-525. Crossref, Medline, Google Scholar
210 Kleinman PK, Spevak MR, Hansen M. Mediastinal pseudocyst caused by pharyngeal perforation during child abuse. AJR Am J Roentgenol 1992; 158:1111-1113. Crossref, Medline, Google Scholar
211 Bongiovi JJ, Logosso RD. Pancreatic pseudocyst occurring in the battered child syndrome. J Pediatr Surg 1969; 4:220-226. Crossref, Medline, Google Scholar
212 Cumberland GD, Riddick L, McConnell CF. Intimal tears of the right atrium of the heart due to blunt force injuries to the abdomen: its mechanism and implications. Am J Forensic Med Pathol 1991; 12:102-104. Crossref, Medline, Google Scholar
213 Cohle SD, Hawley DA, Berg KK, Kiesel EL, Pless JE. Homicidal cardiac lacerations in children. J Forensic Sci 1995; 40:212-218. Medline, Google Scholar
214 Baker AM, Craig BR, Lonergan GJ. Homicidal commotio cordis: the final blow in a battered infant. Child Abuse Negl 2003; 27:125-130. Crossref, Medline, Google Scholar

Article History

Published in print: July 2003

Vol. 23, No. 4

Supplemental Material

Metrics

Altmetric Score

PDF download