Child Abuse Visceral Injury

  • Etiology: direct blow to abdomen + shearing forces
  • Imaging: injuries can be multiple + severe, liver injury is most common solid organ injury – look for injury to left lobe from compression against spine, renal injury rare, bowel injury most commonly to duodenum and jejunum, hypoperfusion complex
  • Clinical: is uncommon, usually < 3 years old, delay in seeking care, mortality rate ~ 50%, second most common cause of death after intracranial injury

Cases of Child Abuse Visceral Injury

CT of adrenal hemorrhage
Axial CT with contrast of the abdomen show a low density fluid collection in the right adrenal gland and low density in the posterior aspect of the right kidney.
CT of duodenal hematoma
Contiguous slices from an axial CT with IV and oral contrast of the abdomen shows medial to the ascending colon the contrast-filled lumen of the duodenum narrowing to a point as it nears the midline (above) and then being narrowed as it crosses anterior to the spine (below).
Upper GI of duodenal hematoma in child abuse
AP image from an upper GI exam shows diffuse persistent narrowing of the lumen of the second and third portions of the duodenum.
AXR of chylous ascites in child abuse
CXR AP (left) shows the lungs to be poorly expanded and clear but there are dense areas of callus along the lateral aspect of the right 3rd-5th ribs. Centralization of the loops of bowel were also incidentally noted and confirmed on a subsequent AXR AP (right).
CT of hypoperfusion complex / shock bowel in child abuse
Axial CT with contrast of the abdomen shows periportal edema in the liver, diffusely dilated and hyperenhancing loops of small bowel and a narrow caliber inferior vena cava.