Imaging of child abuse

The use of imaging for the diagnosis of child abuse has advanced dramatically since Caffey's(3) initial descriptions of the association of unexplained subdural hematomas and long-bone fractures in infants. Ln 1953, Silverman(38) concluded that the skeletal injuries were the result of repetitive, nonaccidental trauma, and by 1962, Kempe et al(16) had coined the term battered child syndrome and presented radiographic skeletal manifestations of abuse. Much work has been done since then to delineate the imaging findings in skeletal and extraskeletal injuries of abused children. Although the awareness of child abuse and its imaging characteristics has grown, the numbers of fatally injured children are increasing. At least 2000 children die annually in the United States as a result of physical abuse.(8) In addition, the proportion of serious injuries caused by abuse has increased significantly.(36) Children under 1 year of age are particularly at risk.(10,31) Risk factors for abuse include low socioeconomic level, prematurity, physical handicap, and low birthweight. Males, stepchildren, and twins are vulnerable as well.(27,36) imaging studies provide the basis for a diagnosis of abuse in many cases; awareness of the imaging patterns in abuse is essential for enhanced detection of these injuries as well as for a complete understanding of the problem.