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Society for Pediatric Radiology – Poster Archive
Final ID: Poster #: EDU-095
Chest CT in the Evaluation of Child Abuse
Purpose or Case Report: The aim of this exhibit is to familiarize the radiologist with low dose chest CT technique, articulate advantages of CT in detection of fractures that are occult or indeterminate on skeletal surveys, as well as discuss the limitations of chest CT.
Radiologists play a central role in the detection of non-accidental trauma. After bruising and soft tissue trauma, fractures are the most common inflicted injuries seen in children. Rib fractures are one of the most common fractures identified on skeletal surveys and are one of the most specific injuries in child abuse. Chest CT has been shown to increase detection of rib fractures in child abuse and postmortem studies. In addition, new techniques such as the use of tin filter allow performance of very low dose chest CT. This has led some to advocate for increased utilization of chest CT, as head CT and abdominal CT have already well-established indications for evaluation of child abuse.
Chest CT can be considered in children with negative skeletal survey and high clinical suspicion for child abuse, when the diagnosis of rib fractures is indeterminate, and when the finding of additional or more specific fractures may aid in management, such as in children with both anterolateral fractures and recent cardiopulmonary resuscitation.
Chest CT has some limitations. Uncommonly CT can miss acute nondisplaced fractures demonstrated on radiographs due to lower spatial resolution. In addition, developmental variations in the costochondral junction (CCJ) can mimic healed fractures in CT.
We will provide the protocol we use for low dose chest CT technique and discuss the value of axial oblique and 3-D reconstructions in detection of rib fractures. We will show examples of fractures seen on chest CT which are occult or indeterminate on radiography, such as buckle fractures or fractures in challenging locations such as the CCJ. We will further discuss the strengths of CT in the evaluation of other thoracic injuries of abuse including fractures of the sternum, scapula, and vertebral bodies. Cases of fractures found on post-mortem imaging will be included. Finally, we will also show cases demonstrating the utility of CT in identifying false positives and normal variants that may mimic fractures on radiographs.
Methods & Materials:
Results:
Conclusions:
Radiologists play a central role in the detection of non-accidental trauma. After bruising and soft tissue trauma, fractures are the most common inflicted injuries seen in children. Rib fractures are one of the most common fractures identified on skeletal surveys and are one of the most specific injuries in child abuse. Chest CT has been shown to increase detection of rib fractures in child abuse and postmortem studies. In addition, new techniques such as the use of tin filter allow performance of very low dose chest CT. This has led some to advocate for increased utilization of chest CT, as head CT and abdominal CT have already well-established indications for evaluation of child abuse.
Chest CT can be considered in children with negative skeletal survey and high clinical suspicion for child abuse, when the diagnosis of rib fractures is indeterminate, and when the finding of additional or more specific fractures may aid in management, such as in children with both anterolateral fractures and recent cardiopulmonary resuscitation.
Chest CT has some limitations. Uncommonly CT can miss acute nondisplaced fractures demonstrated on radiographs due to lower spatial resolution. In addition, developmental variations in the costochondral junction (CCJ) can mimic healed fractures in CT.
We will provide the protocol we use for low dose chest CT technique and discuss the value of axial oblique and 3-D reconstructions in detection of rib fractures. We will show examples of fractures seen on chest CT which are occult or indeterminate on radiography, such as buckle fractures or fractures in challenging locations such as the CCJ. We will further discuss the strengths of CT in the evaluation of other thoracic injuries of abuse including fractures of the sternum, scapula, and vertebral bodies. Cases of fractures found on post-mortem imaging will be included. Finally, we will also show cases demonstrating the utility of CT in identifying false positives and normal variants that may mimic fractures on radiographs.
Methods & Materials:
Results:
Conclusions:
More abstracts on this topic:
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Poster____EDU-095.pdf
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