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.

A 5-month-old full-term female infant presented to an outside institution with fever and tachypnea. She was born after an uncomplicated pregnancy and delivery, with an uneventful neonatal course. The parents reported a history of persistent tachypnea, grunting, and episodic nonproductive cough with intermittent wheezing since birth. A chest radiograph obtained at the outside hospital prompted transfer to our institution. The patient's medical history was otherwise unremarkable. There was no history of infectious exposure, recurrent infection, aspiration, or choking. Her immunizations were up to date. Physical examination revealed a temperature of 38.1°C, a respiratory rate of 48 breaths per minute, a heart rate of 158 beats per minute, decreased breath sounds on the left side, and mild suprasternal and intercostal retractions. Pertinent laboratory values, including white blood cell count, were normal. On arrival at our institution, unenhanced chest computed tomography (CT) was performed. The patient underwent surgical resection of the left upper lobe. On the basis of pathology results, ultrasonography (US) of the kidneys was performed and revealed a normal right kidney and a cystic lesion in the left kidney. This cyst increased in size, with interval development of a new cyst at 5-month follow-up. Partial nephrectomy of the left kidney was performed.

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