Tracking Clues: Illuminating the Imaging Findings of Child Abuse (2025)-R7-CPD11-2025

Video Transcription

Video Summary

The session covers three pediatric radiology topics: abusive head trauma (AHT), metabolic bone disease versus abuse on skeletal survey, and preparing radiologists for court testimony.<br /><br />Dr. Yoshima Sashima explains that diagnosing AHT is complex but high–predictive value clues include unexplained or multifocal subdural hemorrhage (common in AHT), cerebral ischemia, lack of scalp swelling, and severe retinal hemorrhage. Because most victims are under 1 year (open fontanelle), cranial ultrasound can be a rapid, bedside, radiation-free first-line tool to assess extracranial hematomas, skull fractures, intracranial hemorrhage, and hypoxic-ischemic injury using B-mode and Doppler. She highlights pitfalls such as mirror-image artifact from extracranial hematomas and shows cases demonstrating fracture-associated hemorrhage and Doppler signs of poor prognosis. A suggested workflow uses ultrasound first in stable infants with open fontanelle, escalating to CT/MRI for significant hemorrhage or mass effect.<br /><br />Dr. Jeffrey Autgen reviews differentiating metabolic bone disease (especially rickets, scurvy, Menkes) from abuse: metabolic disease is systemic, affects all bones, and has characteristic patterns; rickets shows metaphyseal fraying/cupping and poor mineralization but can be misused legally.<br /><br />Dr. Peter Strauss outlines court preparation: reports are legal documents; negotiate subpoenas; review all imaging/records and relevant literature (including “denialist” sources); meet attorneys to educate them; use clear images/diagrams; testify within expertise; focus on educating the court and learn from each case.

Keywords

abusive head trauma

pediatric cranial ultrasound

subdural hemorrhage

retinal hemorrhage

skeletal survey differential diagnosis

metabolic bone disease rickets scurvy Menkes

radiologist court testimony preparation