Local Time : 06:28 CET

E³ 1526b - Imaging in child abuse: an update

Saturday, March 4, 14:00 - 15:30 Room: O Session Type: E³ - ECR Master Class Topic: Paediatric Moderator: G. M. Magnano (Genoa/IT) Add session to my schedule In your schedule (remove)


A. Skeletal fractures

R. R. van Rijn; Amsterdam/NL

Learning Objectives

1. To understand the basic mechanisms.
2. To learn about fracture patterns suggestive of abuse and the evidence behind.
3. To become familiar with the most important differentials.


In childhood, fractures are a common cause for presentation in an emergency department. Estimates in the USA report that approximately 15% of all emergency department presentations in this population are related to fractures. Although the vast majority of all fractures are accidental they also represent the second most common finding in cases of physical child abuse. Radiologists may, therefore, be amongst the first caregivers to discover an indication of child abuse. To detect indicators of child abuse it is of importance to interpret all childhood fractures in relation to the provided clinical history and trauma mechanism. In this lecture, attention will be given to imaging techniques and the applicable protocols as well as fractures, frequently seen in child abuse, and their differential diagnosis. Finally, the need for collaboration with clinicians in the diagnosis of child abuse will be discussed, this as the diagnosis can never be solely based on radiological imaging but always on a combination of clinical, investigative and social findings.


B. Abusive head trauma

C. Adamsbaum; Le Kremlin-Bicêtre/FR

Learning Objectives

1. To understand the basic mechanisms.
2. To learn about imaging findings suggestive of abuse.
3. To become familiar with the differentials and the controversies.


Radiologists play a key role in the early diagnosis of child abuse. Imaging must be performed and interpreted with rigour. The recommended guidelines for imaging in children younger than 2 years suspected of abuse include a highly detailed complete skeletal survey with centred views, and brain CT (or MRI if the child is free of neurological symptom). The use of abdominal imaging is debatable if the child has no symptoms. All siblings younger than 2 years should be assessed in the same way. To determine if the pattern may be of "age-different" lesions is a major point and must be assessed on robust criteria. This provides a strong argument for the diagnosis of abuse and also indicates repetitive violence which occurs in more than half of the cases. The differential diagnoses must be exhaustively discussed. However, they are usually easy to rule out. A changing or absent history of trauma in a non-ambulatory child is a key diagnostic sign for abuse. Radiologists must communicate clearly the suspicion of abuse and its degree of certainty to clinicians. The medical challenge is only to protect the child.


C. The medico-legal issues

A. C. Offiah; Sheffield/UK

Learning Objectives

1. To learn about the information required by any court, and how to structure the radiological report.
2. To recognise imaging markers suggestive for abuse and how to raise the suspicion.
3. To become familiar with the terms that should be used when highly specific imaging markers for abuse are identified in an otherwise normal infant.


The presentation will be given in the context of suspected child physical abuse and will cover both the written report and court attendance. The various types of written report (clinical report, police statement, witness statement and expert report) will be covered, including what is expected from the individual who is providing the report or statement. The importance of the 3 Rs (retain, record, reveal) and 3 Is (independence, impartiality, integrity) will be emphasised and the manner in which witnesses should conduct themselves while giving oral evidence will be addressed. Common pitfalls in both written and oral evidence that should be avoided will be highlighted where relevant throughout the talk.

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