Paediatric-Non-Accidental Injury (NAI)

Paediatric-Non-Accidental Injury (NAI)Created OnMay 7, 2020Last Updated OnOctober 26, 2020byadmin You are here: Main Radiology Paediatric-Non-Accidental Injury (NAI) < All Topics Table of Contents Injuries Intracranial bleeding especially subdural hemorrhage Diffuse axonal injury or retinal hemorrhages Skull fracture Ruptured viscera Genital trauma Long bone fractures in a child under the aged of 3 Unusual injury marks: bites, cigarette burns, rope marks, bruises Neglect: malnutrition, poor hygiene Emotional disturbance Investigations Full clinical examination: centiles, documentation of injuries. Full blood count, Coagulation Profile Fundoscopy by ophthalmologist Skeletal survey CT brain if history of concern MRI if history of shaking Skeletal Survey AP/PA chest view (to image clavicles, ribs and scapulae) AP abdomen view (to image spine and pelvis) AP view of both upper limbs (shoulder to metacarpals) AP view of both lower limbs (hip to tarsal bones) Lateral thoracolumbar spine (to include spinous processes) Lateral skull Spiral midshaft right femoral fracture in a non-mobile infant. Multiple fractures seen on the skull of a 2-month-old male child as a result of physical abused. For an accurate diagnosis is to be made, we need to put in consideration of both clinical history and understanding of trauma mechanisms. A history of fall from a height of less than 1.25 m (4 feet) is rarely associated with a serious head injury and therefore more sinister events need to be considered. No skull fracture pattern is pathognomonic of NAI Parietal and occipital fracture are more common than frontal bone fractures. However, accidental skull fractures also typically present as simple linear fractures within the parietal region and therefore each case must be considered individually CT Brain Infant with abusive head injury (Shaken Baby Syndrome) – with SDH typically <2 years old These children demonstrate nonspecific clinical signs of brain injury, including: Irritability, Vomiting Bulging anterior fontanelle ; Sudden increased in head circumference Pallor with anemia Lethargy, coma, or seizures Retinal hemorrhages, skull and skeletal fractures commonly found, indicating major traumatic force that usually does not match the history. Intracranial bleeding should be suspected if there is a witnessed deterioration in neurologic status after an unintentional head injury. Abnormal findings for each type of intracranial bleed Type of bleeding Characteristic EDH: Extradural / Epidural Haemorrhage Bulge along inner edge of the skull (LENTIFORM (‘LENS’) shape) SDH: Subdural Haemorrhage Crescent along the inner edge of skull (CONCAVE shape) SAH: Subarachnoid Haemorrhage Net-shape along the fissures (Not confined by sutures) ICH: Intracerebral Haemorrhage Bright object in the gray matter IVH: Intraventricular Haemorrhage Bright object in the ventricle This large temporal Extradural Haematoma (EDH) is associated with midline shift and compression of the ventricular system. The dark swirls within the haematoma represent rapid arterial bleeding. An infant presented in coma with pupillary dilation. No significant trauma history....

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