Physicians have an ethical and legal mandate to identify abused children so that they may be protected from further harm and are simultaneously required to think broadly and objectively about differential diagnoses. The medical literature is replete with examples of medical diseases that mimic abuse, potentially leading to misdiagnoses and subsequent harm to children and families. This review highlights some of the common and uncommon diseases that mimic physical and sexual abuse of children. Christian provides medical-legal expert work in child abuse cases. Published January 25, Accessed January 13, 2.
Imaging in Child Abuse: Overview, Radiography, Computed Tomography
February 1, Child abuse is a relatively common problem in our society. S it is estimated that 4 million children a year are abused in some manner. At least two thousand children die as a result of this abuse. This overview focusses on the role of diagnostic imaging in depicting the findings that are specific for child abuse. Awareness of the radiologist is essential in finding these skeletal and CNS injuries in order to document child abuse, to stop further abuse and to protect siblings.
Mar 23, · In infants younger than 1 year, these fractures are usually found in the distal femur, the proximal tibia, the distal tibia, or the proximal humerus as a .
Research News April Five cavaliers are diagnosed with congenital diaphragmatic hernias and tension gastrothorax. All of the affected cavaliers were intact males, four of them between 2. The cases occurred over a period of 12 years. The symptoms were rapid breathing and shortness of breath. In all of the dogs, chest x-rays showed a gas—fluid-filled structure on the left side of the chest, which was found to be the stomach see photo at right , with some degree of lung collapse and shift to the opposite side.
The clinicians determined that the dogs developed “tension gastrothorax”, which describes the stomach herniating through a congenital diaphragmatic defect into the thorax and distended due to being filled with trapped air. One of the CKCSs was euthanized, and surgery was performed on the other four. The hernias were repaired and all four of the surviving dogs recovered successfully.
The Radiology Assistant : Diagnostic Imaging in Child Abuse
Download powerpoint The most common fracture site in both the abuse and non-abuse groups was parietal,w30 and the most common fracture type was linear. Meservy and colleagues found no significant differences between the two groups with respect to depressed, diastatic, or complex fractures but found that multiple or bilateral fractures or those that crossed suture lines were significantly more common in abused children.
We have also identified features related to the child or type of fracture sustained that should alert clinicians to consider physical abuse as a possible cause box 2.
Home > Judgments > archive. Re D (A Child)  EWHC (Fam) Judgment of Roberts J after a day fact-finding hearing, making adverse findings of non-accidental injury against a father.
In one mouse model, inadequate VEGF causes mesenchymal cells in bone to become adipocytes rather than osteoblasts: Egyptian mummy ladies had much less osteoporosis for their ages than our ladies do; perhaps they were more active physically than American folks today Lancet This is a topic under “nutritional disease” and of course in childhood it produces rickets. Adults with dietary calcium deficiency poverty, elderly “tea and toast” eaters, people subsisting mostly on vegetables or malabsorption especially, remember celiac sprue and post-bypass surgery for obesity — South.
The skeleton will even light up on bone scan why? Even people “who are not at risk” turn up with it, and curiously, the “complementary medicine community” vitamin buffs are paying this very little attention.
Useful Links Metaphyseal Fractures Metaphyseal fractures are also known as corner fractures, bucket handle fractures or metaphyseal lesions. It refers to an injury to the metaphysis which is the growing plate at each end of a long bone such as tibia, femur, etc. The metaphysis is not actually a bone but is a piece of cartilage it only fully ossifies when we are adults.
For years, the mechanism for such injury was thought to be a twist and a pull being applied to the limb rather than any direct force or fall. The amount of force needed is not known but it is thought to be outside of normal or rough handling. Fortunately, in more recent years, it has been acknowledged that nothing is pathognomonic of NAI and that everything is capable of having an accidental or medical cause.
The ability to identify child abuse constitutes an important concern to those involved in the medical care of children. Studies show that at least 10% of children under 5 years old who are brought to the emergency room with alleged accidents have actually suffered nonaccidental trauma.
View Media Gallery Degree of confidence Subdural hematomas may be hypoattenuating on the day of trauma because of various factors. For example, in children with anemia, the blood may be hypoattenuating. Disruption of the arachnoid membrane during trauma may allow CSF to mix with the subdural hematoma, diluting the hemorrhage and reducing its attenuation on CT scans.
On CT scanning, nondepressed fractures of the calvaria may be missed, especially if the fracture lies in an axial plane parallel to the plane of imaging. Nonhemorrhagic brain contusions, early global ischemia, and shear injury diffuse axonal injury may be missed on CT scanning because of limitations in resolution that cause subtle differences in tissue attenuation to be overlooked. Magnetic Resonance Imaging The brain parenchymal injuries most commonly observed in cases of child abuse are shear injury, edema, and contusion.
At the first visit on the six day after onset, the X – ray was normal. On the same day, MRI findings was osteomyelitis in the middle phalanx. However, the serum inflammatory response was negative. Serum rheumatic response was also negative, but antinuclear antibody was positive at times. On the 12th day after onset of disease, the vicinity of the epiphyseal line of the middle phalanx became erosive.
At this point, from literature search and pediatric consultation, we got a diagnosis of Microgeodic disease.
Programar nos vuelve locos y más cuando la legislación está cambiando año tras año. En 11 enero, ; 7.
This matter concerns two children MY 22 months and MN 7 months. Their parents are CM 22 years and LW 24 years. Up until 25 April both children were in the care of their parents. In the early hours of that morning MN collapsed and was admitted to hospital, he was found to have an acute subdural haemorrhage for which there was no reported event that accounted for these injuries. He was also found to have a chronic subdural haemorrhage as well as posterior rib fractures both sides likely to have been caused by squeezing and metaphyseal fractures caused by flailing or a pulling mechanism.
Following his discharge from hospital he was placed with foster carers on 7 June These young parents’ lives have been put under intense scrutiny during this hearing. They have each suffered extremely difficult upbringings where they have each been the subject of sexual abuse and had very disrupted care. Inevitably those experiences will have an impact on how they themselves parent. In addition the mother tragically lost her first child, L, due to medical causes wholly unrelated to the difficulties with the children in this case.
Failure to cross-examine father The judge made findings against the mother to the effect that she was in breach of the written agreement. In particular, the judge accepted as he was entitled to do the evidence of PC Tonse, that the mother had told her she had been the victim of two previous assaults at the hands of the father. That she had said this was denied by the mother, who gave evidence and was cross-examined.
At the hearing, counsel Mr Richardson for the father offered to call the father in order for him to be cross-examined about the events of 30 December and, no doubt, in relation to the two earlier alleged incidents. No party required him to be called.
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It is important to note that in the cases of accidental head injury that were accompanied by retinal hemorrhages, there was a clear history of head trauma that was given by the caregivers when the child first presented for care. It is also noteworthy that the types of retinal hemorrhages present in children with accidental head injury were distinctly different from those present in children with abusive head injury in that they were confined to the intraretinal layer, did not cover the macula, and did not extend to the periphery of the retina.
Other studies have stated there is no clinical difference to differentiate between them. Why would there be a consistent difference? A logical answer would be that the second set of hemorrhages assumed to be from non-accidental injury may come from some other cause. Why would a whiplash-impact of similar force produce one set of symptoms in cases of accident and another in cases of assumed abuse?
Characteristics that distinguish accidental from abusive injury in hospitalized young children with head trauma. When a child is brought to the hospital in circulatory arrest, these hemorrhages raise the question of preceding trauma, frequently child abuse. We therefore undertook a prospective study to evaluate whether cardiopulmonary resuscitation can cause retinal hemorrhage.
Am J Forensic Med Pathol. Retinal hemorrhage in an infant after cardiopulmonary resuscitation. Unexplained retinal hemorrhages in infants are usually indicative of child abuse. We present the case of an infant with retinal hemorrhages following cardiopulmonary resuscitation, who had not been abused. Cardiopulmonary resuscitation should be added to the list of causes of retinal hemorrhages in infants and children.
Received Apr 11; Accepted May Abstract Fractures are reported to be the second most common findings in child abuse, after skin lesions such as bruises and contusions. This makes careful interpretation of childhood fractures in relation to the provided clinical history important. In this literature review, we address imaging techniques and the prevailing protocols as well as fractures, frequently seen in child abuse, and the differential diagnosis of these fractures.
The use of a standardised protocol in radiological imaging is stressed, as adherence to the international guidelines has been consistently poor. As fractures are a relatively common finding in childhood and interpretation is sometimes difficult, involvement of a paediatric radiologist is important if not essential.
Dating fractures in infants The remodelling process is difficult, somers jm, boston children’s hospital outside of vitamin e on the edge. Whilst fracture dating of rib fracture in infants. Aim: rib fractures on chest results: a fatally abused 7-month-old boy.
See same patient in Fig. A, AP portable supine radiograph obtained at the time of resuscitation shows fractures of the right sixth-to-ninth ribs without frank callus formation arrows. There is a healing fracture of the right tenth rib circle. There is a right tension pneumothorax. The child was pronounced dead and multiple fractures were noted on SS, including over 24 rib fractures. C, Corresponding axial specimen radiograph shows disruption of the inner rib cortex black arrow.
D, Frontal specimen radiograph shows fractures of the right tenth black arrows and eleventh curved arrow ribs. Note that the relatively solid SPNBF thin white arrows blends with mature hard callus with trabecular matrix surrounding the fracture site thick white arrows. The eleventh rib fracture shows no healing. E, Axial specimen radiograph of the right tenth rib shows the mature fracture callus white arrows.
Although most radiologists make assessments of fracture healing with accidental fractures on a daily basis, the evidence base for dating fractures, particularly in the abusive setting, remains incomplete 3 , 5 —7, 10 , This is remarkable when one considers the important implications of these radiologic assessments.
Fractures in children younger than 18 months
I have been conducting a fact-finding hearing in care proceedings relating to a young child, C Scully-Hicks hereafter “C”. The fact-finding hearing, however, is not directly related to C but rather to the tragic death of C’s young sister, Elsie Scully-Hicks on 29th May I accept immediately that the facts of this case raise serious issues that will be of genuine public concern. I could not permit the criminal trial to be derailed if my judgment had come into the public domain too early.
I make it quite clear, however, that the Reporting Restriction Order would only last until the conclusion of the criminal trial.
Purpose: In the musculoskeletal system, structure dictates function and the development of pathology. Interpreting wrist structure is complicated not only by the existence of multiple joints and ligamentous structures but also by variability in bone shapes and anatomical patterns.
On 19 April a four month old child, M, suffered a catastrophic collapse at the home which she shared with her parents. At the time she was in the sole care of her father in a bedroom at the property. She stopped breathing for a period of about six minutes and had to be revived on a table in the kitchen where her father administered cardiopulmonary resuscitation.
She was taken to hospital by ambulance following a call which was made by her mother. She was subsequently found to have a number of injuries including extensive bilateral, multilayer retinal haemorrhaging; fresh subdural haemorrhages in all three intracranial compartments; and a moderate degree of encephalopathy. In addition, there were a number of petechial bruises on her body which were mapped and charted on photographs.