Imagerie de la maltraitance chez l’enfant

Abstract

The diagnosis of abuse is often supported by the findings of skeletal and brain imaging. On skeletal radiographs, the main diagnostic argument is the presence of fractures of different ages and/or specific locations (epiphysometaphyseal, posterior arches of the ribs, etc.). Bone scintigraphy is useful for detecting recent infra-radiological lesions. Prognosis depends mainly on damage inflicted on the brain. Brain trauma is often serious, and is the leading cause of death. Brain damage is caused by violent shaking, sometimes associated with a final impact. The brain may be injured despite the absence of any detectable skeletal, dermal, or ophthalmic injury. If abuse is suspected, brain imaging (computed tomography scan in the emergency setting, often supplemented with magnetic resonance imaging in the subacute phase) should be systematic in children younger than 2 years. Lesions may include diffuse bilateral subdural hematomas and deep injury (inter hemispherical tentorium) or intra parenchymal injury (contusion, swelling, anoxic-ischemia or shear damage). Organ damage is rare and non-specific, but must be carefully searched, at least with ultrasound, in young children in this context. Image appropriateness and quality together with the accuracy of interpretation are fundamental for the diagnosis of child abuse that always has very serious consequences. The presence of lesions of different ages is an important but inconstant diagnostic feature to recognize.