Pediatric Nonaccidental Abdominal Trauma: What the Radiologist Should Know

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.

Physical child abuse demands increased awareness during health and socioeconomic crises like COVID-19

“…TEN bruising in a child < 4 years or any bruising in a child < 4 months has a sensitivity of 95% and specificity of 84% for prediction of abuse (Pierce et al 2010). Abdominal bruising is rare, but warrants investigation of the internal organs, as 10% of victims will have intra-abdominal injury (Sheybani et al 2014).…”

ACR Appropriateness Criteria ® Suspected Physical Abuse—Child

“…Up to 10% of abused children have intra-abdominal injury [49]; 15% of children aged 0 to 4 years hospitalized for abdominal injury are victims of child abuse [70,71]. Victims of nonaccidental abdominal trauma tend to be younger and have a more delayed presentation than those who experience accidental trauma [72].…”

“…CT abdomen and pelvis with contrast. CT of the abdomen and pelvis with intravenous contrast is utilized for children with suspected intra-abdominal and/or intrapelvic injury [49]. Portal venous phase imaging is most helpful for detecting solid organ injury.…”

Unusual presentations of child abuse: A report of two cases and the role of imaging

“…[6] Chest findings include pulmonary opacities due to lung contusions with rib fractures, pneumothorax, hemothorax, and rarely vascular injuries. [7] Penetrating lung injury was seen in the second case resulting in metallic lung impalement or intrapulmonary aberrant needles. Intrapulmonary aberrant needles are very rare in clinical practice with its most common cause being the intrathoracic migration of pins and wires used in the treatment of upper extremity fractures and dislocations.…”