RESUMEN
OBJECTIVE: To determine if extracranial soft-tissue swelling is an expected postmortem finding or a sign of trauma. MATERIALS AND METHODS: Extracranial soft-tissue thickness was measured at 5 standardized locations on postmortem skull films obtained of 18 infants with no evidence of trauma on autopsy. The same measurements were performed on the skull films of 100 living children, all less than 3 years old and without clinical history of trauma. RESULTS: Extracranial soft tissues measured only slightly greater in the postmortem group than on films of living children; however, the difference did achieve statistical significance. CONCLUSION: Minimal extracranial soft-tissue swelling is a normal finding on a postmortem skeletal survey. The presence of substantial or asymmetric extracranial soft-tissue swelling should be viewed with suspicion for trauma.
Asunto(s)
Traumatismos Craneocerebrales/diagnóstico por imagen , Edema/diagnóstico por imagen , Traumatismos de los Tejidos Blandos/diagnóstico por imagen , Autopsia , Maltrato a los Niños/diagnóstico , Humanos , Lactante , RadiografíaRESUMEN
PURPOSE: To evaluate the incidence and specificity of fracture of the first rib as an indicator of child abuse and to determine a mechanism of fracture. MATERIALS AND METHODS: All infants and young children with rib fractures who were seen at the radiology department of an academic medical center over a 2-year period were identified from the radiology data base. RESULTS: Rib fractures were attributed to child abuse in 12 of 35 children identified. Apart from a neonate with congenital osteogenesis imperfecta, only three children, all abused, had first-rib fracture, one bilaterally. Two additional children with first-rib fracture were identified from years prior to the study period. In four children, first-rib fractures were "isolated," without fractures of adjacent bones. CONCLUSION: Child abuse should be considered in cases of pediatric rib fracture, particularly fracture of the first rib. Possible mechanisms for first-rib fracture include impact force, compressive force, and shaking or acute axial load (slamming), which cause an indirect fracture.
Asunto(s)
Maltrato a los Niños/diagnóstico , Fracturas de las Costillas/diagnóstico por imagen , Centros Médicos Académicos , Fenómenos Biomecánicos , Enfermedades Óseas Metabólicas/diagnóstico por imagen , Lesiones Encefálicas/complicaciones , Lesiones Encefálicas/diagnóstico , Preescolar , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Osteogénesis Imperfecta/diagnóstico por imagen , Radiografía , Sistemas de Información Radiológica , Estudios Retrospectivos , Fracturas de las Costillas/complicaciones , Sensibilidad y Especificidad , Estrés Mecánico , Heridas no Penetrantes/diagnóstico por imagenRESUMEN
Shaken baby syndrome consists of intracranial and intraocular hemorrhage in the absence of signs of direct trauma in infants who have sustained whiplash/shaking injuries. We evaluated 14 consecutive cases of presumed shaken baby syndrome seen at the University of Michigan Hospitals, Ann Arbor, between August 1983 and March 1988, to determine if the severity of retinal hemorrhage was predictive of the severity of acute neurologic injury. The severity of retinal hemorrhage was based on the type and size of hemorrhage and the extent of fundus involvement. We found a significant correlation between retinal hemorrhage severity and acute neurologic findings. Diffuse fundus involvement, vitreous hemorrhage, or large subhyaloid hemorrhages were associated with more severe acute neurologic injury.