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Non-accidental injury (NAI) in children under the age of 17 years has an estimated incidence in the USA of 2.5%, and is considered to be on the increase.1 The range of skeletal, intracranial, and orbital manifestations in NAI have been well described.2-8 In comparison, visceral manifestations (excluding the superficial and cutaneous injuries) are much less common and less well recognised; they are considered to contribute less than 2% of injuries in NAI.9
Abdominal injuries in NAI arise mainly from blunt trauma, and include contusion, laceration, and rupture of solid or hollow viscera, for example of the liver, spleen, pancreas, kidneys, and bowel. Duodenal haematomas and mesenteric tears may also occur. Vascular injuries are less common and include avulsion of the superior mesenteric artery and pseudoaneurysms of the abdominal aorta.10 Chylous ascites after abdominal trauma has been described.11
Blunt thoracic injuries commonly result in rib fractures in the infant, but intrathoracic visceral injuries are much less common than abdominal visceral injuries.12 The former include lung contusions, chylothoraces, and cardiac lacerations and rupture.11 13
Superficial and cutaneous injuries, for example, bruises, cuts, burns, injuries to the pinna, frenulum of the mouth, and genitalia can impart information on the mechanisms of injury. They are well described and are not discussed in detail in this paper.
Patients with visceral manifestations of NAI have been selected from a group of 300 patients referred or admitted for alleged physical abuse. The cases include pharyngeal, abdominal, and pelvic trauma. The radiological findings are illustrated and correlated in all cases bar one, with surgical or postmortem findings.
PATIENT 1: PHARYNGEAL TRAUMA AND PHARYNGEAL FOREIGN BODY
A 7 week old infant was brought by her father to a casualty department with respiratory distress. Stridor, drooling, and mild desaturation were noted. She had blood in the oropharynx, and a soft tissue …