Infants are at risk for fatal physical abuse yet may present to care multiple times with inflicted trauma before abuse is diagnosed and the infant is protected. Prompt identification of at-risk infants is essential to protection from ongoing abuse. Sentinel injuries are unexplained minor injuries in young infants that are appreciable on physical exam. Examples of sentinel injuries include bruising, subconjunctival hemorrhages, and intra-oral trauma. These injuries can be a subtle external sign of concurrent clinically occult internal injuries (e.g., skeletal, abdominal, intracranial injuries) in a well-appearing infant or may be an early warning that foretells more significant trauma in the future. Identification and evaluation of these infants with appropriate imaging has been highlighted as one approach to ensure that abuse is promptly detected, injuries are addressed, and the infant is protected. In this multidisciplinary educational presentation made in collaboration with child abuse pediatricians and pediatric radiologists, we will: (1) review different types of sentinel injuries; (2) discuss current evidence and guidance for performance of imaging (skeletal survey, abdominal CT, neuroimaging with MRI or CT) when a sentinel injury is identified; (3) discuss the interpretation and significance of imaging findings; (4) provide imaging examples of these injuries; and (5) discuss gaps in the literature while highlighting opportunities for collaboration between child abuse pediatricians and pediatric radiologists to improve the care of these infants. Following completion of this educational module, our goals are that the participant will better understand the clinical context of sentinel injuries and have a baseline knowledge to make an appropriate imaging plan for these infants. Read More

Meeting name: SPR 2022 Annual Meeting & Postgraduate Course , 2022

Authors: Henry M Katherine, White Ammie, Servaes Sabah, Wood Joanne

Keywords: Child Abuse, Sentinel Injuries, Skeletal Survey

Magnetic resonance imaging (MRI) has historically been restricted for patients with pacemakers, defibrillators, or other cardiac implantable electronic devices (CIEDs) due to safety concerns. Despite the introduction of MR conditional pacemakers in 2008, access to MRI in patients with CIEDS remains limited. MRI remains the diagnostic imaging study of choice for many indications and is necessary to prevent delayed diagnosis and the decision to proceed with MRI should follow a rigorous risk benefit assessment: Risks of: Lead heating causing injury at their tips Increased pacing thresholds Sudden battery depletion Inappropriate sensing/pacing The location of the image should be considered because if the request includes the area of the CIED then potential artifacts may decrease the diagnostic quality. However, an MRI remote from the location of the CIED entails a negligible risk of lead heating and MRI may be performed safely with continuous patient monitoring throughout the scan. In addition, in pediatric patients the necessity of anesthesia or sedation must be well-thought-out as it conveys additional risk to the patient. There is growing evidence from adult literature that MRI may be performed safely in patients with CIEDs with transvenous leads when appropriate protocols are followed. The Heart Rhythm Society (HRS) 2017 expert consensus statement indicates that MRI is reasonable in patients with MR non-conditional transvenous CIEDs if there are no fractured, epicardial, or abandoned leads. The Pediatric and Congenital Electrophysiology Society (PACES) of 2021 included that MRI may be considered in pediatric patients with epicardial or abandoned leads on a case-by-case basis. However, performing MRI in patients with CIEDs is a resource-intensive service and requires rigorous implant investigation, preparation, and planning as well as close coordination between treating physicians and radiologist. This educational exhibit summarizes current literature on the safety of MRI in patients with CIEDs and takes examples from our practice to build an evaluation program that allows for safe access to MRI in patients with CIEDs Read More

Meeting name: SPR 2023 Annual Meeting & Postgraduate Course , 2023

Authors: De Leon-benedetti Laura, Ramirez Suarez Karen, Otero Hansel, Rapp Jordan, Biko David, Smith Christopher, Serai Suraj, White Ammie

Keywords: Cardiac, Magnetic Resonance