Germaine Colton,  Richards Allyson,  Tocchio Shannon

Final Pr. ID: Poster #: CR-035

Congenital insensitivity to pain (CIP) is a rare genetic condition in which patients are born with the absence of nociception at birth. These patients do not feel painful or noxious stimuli including pain from infection, inflammation or heat. The inability to feel and respond to painful stimuli leads to repeated injuries and infections, as well as poor wound healing. Children born with CIP are often misdiagnosed as being victims of abuse due to the nature and repetitiveness of their injuries. While rare, it is essential to understand the distinguishing features of CIP and how it differs from non-accidental trauma (NAT). In this case presentation, we provide an overview of the types of fractures and injuries common in patients with CIP, review characteristic imaging findings of CIP and discuss pitfalls specific to radiology.

CONTENT ORGANIZATION:
1) Overview and epidemiology of CIP.
2) Imaging findings characteristic of CIP.
3) Other clinical findings and injuries specific for CIP.
4) Differentiating CIP from NAT.
5) Review follow-up imaging considerations and discuss a radiologist’s role in managing a patient with CIP.

SUMMARY:
1) The major teaching points of this case presentation include:
2) Understanding the clinical presentation and distinguishing imaging findings common in CIP.
3) Recognizing CIP and differentiating it from other types of accidental vs non-accidental trauma is an essential component in patients receiving appropriate care.
4) Providing the correct recommendations for imaging follow-up helps provide improved care to patients with CIP. Read More

Authors:  Germaine Colton , Richards Allyson , Tocchio Shannon

Keywords:  Genetics, Non-Accidental Trauma, Infection

Warner Christopher,  Maguire Sabine,  Miller Angie,  Trefan Laszlo,  Fadell Michael

Final Pr. ID: Poster #: SCI-057

Fractures are a common manifestation of physical child abuse, and when present can have considerable bearing on the legal process. Although the timing of skeletal injury and healing is of great importance in forensic cases, the dating of fractures in the age group in which fractures from physical abuse most frequently occur is largely based on the radiologist’s personal experience as opposed to primary research. A full understanding of the radiological features of healing in infant fractures will enhance the assessment of fracture dating in cases where the time of injury is unknown, such as suspected abuse. The objective of this study was to describe the timing of fracture healing in infants using previously defined radiographic signs of fracture healing. Read More

Authors:  Warner Christopher , Maguire Sabine , Miller Angie , Trefan Laszlo , Fadell Michael

Keywords:  Healing Fracture, Fracture Healing, Non Accidental Trauma, Abuse, Long Bone

Garg Vasant,  Partovi Sasan,  Vasavada Pauravi,  Weinert Dayna,  Berlin Sheila,  Mcdavid Lolita,  Sivit Carlos

Final Pr. ID: Poster #: CR-040

We present a rare Case Report Exhibit of a 4-year child with myositis ossificans secondary to non-accidental trauma. The child presented to the ER complaining of a headache. Head CT was unremarkable. However, initial physical examination revealed numerous bruises over the lower abdomen and thighs including belt marks. The patient also demonstrated restricted range of motion. A skeletal survey showed multiple remote fracture deformities and myositis ossificans extending the length of both femurs. Although myositis ossificans frequently occurs in athletes who sustain blunt injury, this unfortunate case occurred secondary to non-accidental trauma and specifically the caregiver intentionally standing on the patient’s legs. Pediatric radiologists should be mindful of non-accidental trauma as a potential cause of myositis ossificans, especially in very young children and when multifocal. Read More

Authors:  Garg Vasant , Partovi Sasan , Vasavada Pauravi , Weinert Dayna , Berlin Sheila , Mcdavid Lolita , Sivit Carlos

Keywords:  myositis ossificans, non-accidental trauma, child abuse

Tutman Jeffrey,  Hedlund Gary

Final Pr. ID: Poster #: SCI-047

Accurate imaging characterization of chronic subdural hemorrhage (cSDH) has clinical and forensic implications, and continues to challenge the radiologist. The MRI characteristics of surgically proven cSDH were retrospectively reviewed in the context of known pathomorphology of the aging SDH. Read More

Authors:  Tutman Jeffrey , Hedlund Gary

Keywords:  Non-accidental trauma, Abusive Head Trauma

Lucin Michael,  Faruqui Sami,  Sato Yutaka,  Sato T Shawn

Final Pr. ID: Poster #: EDU-095

Because of the consequences of missed non-accidental trauma, it is essential for pediatric radiologists to have a high index of suspicion for injuries related to non-accidental trauma. Certain patterns of fracture raise suspicion for non-accidental trauma and are often considered pathognomonic. We present several cases of fractures that are typically considered pathognomonic for non-accidental trauma that had other non-abuse etiologies. These cases include classic metaphyseal lesions, subdural hematomas and long bone fracture in non-ambulatory patients among others. While there may be non-abuse etiologies of fractures that are classically considered pathognomonic for child abuse, the illustrative cases demonstrate the severe magnitude of injury necessary to produce these findings. This is why it is essential to evaluate the patient history and identify if the resulting injuries are consistent with the history. Read More

Authors:  Lucin Michael , Faruqui Sami , Sato Yutaka , Sato T Shawn

Keywords:  Non-accidental trauma, Fracture

Heitzmann Mark,  Shalaby-rana Eglal,  Deye Katherine

Final Pr. ID: Poster #: SCI-077

Abdominal injuries account for a relatively small percentage of non-accidental trauma. Previous estimates range from 0.5% to 11%. Despite this, abdominal injuries are the second leading cause of death in non-accidental trauma after head injury. Our objective is to assess the prevalence of abdominal injuries in the setting of suspected non-accidental trauma within a large urban children's medical center. Read More

Authors:  Heitzmann Mark , Shalaby-rana Eglal , Deye Katherine

Keywords:  non-accidental trauma, abdominal injuries