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Canty KW, Keogh A, Rispoli J. Neuroimaging considerations in abusive head trauma. Semin Pediatr Neurol 2024; 50:101140. [PMID: 38964816 DOI: 10.1016/j.spen.2024.101140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/04/2024] [Accepted: 05/07/2024] [Indexed: 07/06/2024]
Abstract
This focused review on abusive head trauma describes the injuries to the head, brain and/or spine of an infant or young child from inflicted trauma and their neuroimaging correlates. Accurate recognition and diagnosis of abusive head trauma is paramount to prevent repeated injury, provide timely treatment, and ensure that accidental or underlying medical contributors have been considered. In this article, we aim to discuss the various findings on neuroimaging that have been associated with AHT, compared to those that are more consistent with accidental injuries or with underlying medical causes that may also be on the differential.
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Affiliation(s)
- Katherine W Canty
- Child Protection Program, Division of General Pediatrics, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States.
| | - Abigail Keogh
- Child Protection Program, Division of General Pediatrics, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, United States
| | - Joanne Rispoli
- Division of Neuroradiology, Boston Children's Hospital, Boston, MA, United States
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Tang B, Pophal S, Ganigara M, Funaki B, Robinette M, Ramaiah V, Ghanayem N, Hurley MC, Dyamenahalli U. Early Infantile Diagnosis of Hereditary Hemorrhagic Telangiectasia Complicated by Child Abuse. JOURNAL OF PEDIATRICS. CLINICAL PRACTICE 2024; 12:200111. [PMID: 38828001 PMCID: PMC11138255 DOI: 10.1016/j.jpedcp.2024.200111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 03/22/2024] [Accepted: 03/24/2024] [Indexed: 06/05/2024]
Abstract
We report a rare case of hereditary hemorrhagic telangiectasia (HHT) in a 4-month-old female infant with findings of child abuse. She presented with poor feeding, vomiting, and irritability after a short fall from the bed. Initial evaluation found subdural hematomas, persistent hypoxia, failure to thrive, a frenulum tear, facial lacerations, and bruising. The patient was admitted, and an extensive workup led to the diagnosis of brain and pulmonary arteriovenous malformations and finally the diagnosis of HHT. The subdural hematomas, cutaneous injuries, and oral injury were highly suspicious for child abuse and were reported to Child Protective Services and law enforcement for investigation simultaneous to the medical work-up. Her hospital course was complicated by progressive hypoxemia with radiographic evidence of several large pulmonary arteriovenous malformations, for which she underwent successful embolization. Her head injury was indeterminate for physical abuse in the setting of a medical condition predisposing to intracranial hemorrhage. A few weeks later, she was readmitted with repeat abusive injuries in the form of femur fractures. This case demonstrates the unique diagnostic dilemma when 2 diagnoses are occurring simultaneously-HHT and child abuse-and showcases the importance of a detailed family history, genetic testing, strong multidisciplinary collaboration with a holistic approach and medically informed Child Protective Services systems to ensure accurate diagnoses and safe disposition.
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Affiliation(s)
- Brittany Tang
- Department of Pediatrics, The University of Chicago, Chicago, IL
| | - Stephen Pophal
- Department of Pediatric Cardiology, The University of Chicago, Chicago, IL
| | | | - Brian Funaki
- Department of Vascular and Interventional Radiology, The University of Chicago, Chicago, IL
| | - Mckenna Robinette
- Department of Pediatric Cardiology, The University of Chicago, Chicago, IL
| | - Veena Ramaiah
- Department of Child Advocacy and Protective Services, Pediatric Child Abuse Specialist, The University of Chicago, Chicago, IL
| | - Nancy Ghanayem
- Pediatric Crtical Care, The University of Chicago, Chicago, IL
| | - Michael C. Hurley
- Department of Diagnostic and Interventional Radiology, The University of Chicago, Chicago, IL
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Meunier S, Harroche A, Rauch A, Bally C, Huguenin Y, Voltzenlogel R, Tabélé C, Chambost H, Balençon M. Severe haemorrhages leading to a diagnosis of rare bleeding disorder occur at a very young age: A study from the FranceCoag network. Haemophilia 2024. [PMID: 38738973 DOI: 10.1111/hae.15033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/30/2024] [Accepted: 05/01/2024] [Indexed: 05/14/2024]
Abstract
INTRODUCTION In the context of severe unexplained haemorrhage (SH), it is usual to seek haematological evaluation and investigate for an inherited rare bleeding disorder (IRBD). In such circumstances, appropriate screen can discriminate between IRBD and suspected child abuse. Yet, little information is available about the frequency of SH in the population of patients with IRBD. AIM To collect epidemiologic data about SH and IRBD. METHOD The database of the FranceCoag network has collected information about IRBD since January 2004. Based on data gathered up to 16 March 2022, a retrospective search was conducted for of SH events having occurred before or at the time of IRBD diagnosis. Demographics and diagnosis circumstances were retrieved, as well as information about SH, defined as any life-threatening bleeding or intracranial haemorrhage. RESULTS Among the 13,433 patients of the database, 109 (0.8%) fulfilled inclusion criteria including a known date of IRBD diagnosis, haemophilia A or B (HA/HB) being the most frequent (82.5%). IRBD was discovered as a consequence of an SH event in 82.6% of the cases while CNS was involved in 55%. Severe and moderate HA/HB and other severe IRBD presented significantly more intracranial haemorrhage (p < .02) and a lower age at diagnosis (p = .03). CONCLUSIONS These data support that any unusual SH should raise a suspicion of IRBD. Particularly before 1-year of age, it is suggested to first confirm moderate or severe haemophilia and severe IRBD by standard coagulation tests (APTT, PT and fibrinogen), combined with a clotting FXIII assay as first-line investigation. Subsequent assays of coagulation factors should be performed in the case of abnormal values, in second-line investigation.
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Affiliation(s)
- Sandrine Meunier
- Hospices Civils de Lyon- Centre de Référence Hémophilie - Unité d'Hémostase Clinique CHU de Lyon, Bron, France
| | - Annie Harroche
- Service d'Hématologie Clinique Centre de Traitement de l'Hémophilie, Hôpital Necker Enfants Malades, AP-HP, Paris, France
| | - Antoine Rauch
- Unité d'Hémostase Clinique et Biologique - Pôle d'Hématologie Transfusion - Institut Cœur Poumon, Lille, France
| | - Cécile Bally
- Service d'Hématologie Clinique Centre de Traitement de l'Hémophilie, Hôpital Necker Enfants Malades, AP-HP, Paris, France
| | - Yoann Huguenin
- Centre de Ressources et de Compétences Maladies Hémorragiques Constitutionnelles, Bordeaux, France
| | | | | | - Hervé Chambost
- Centre de Traitement des Hémophiles, Hôpital Universitaire La Timone, Marseille, France
| | - Martine Balençon
- Service de Pédiatrie, CHU de Caen & Université de Caen Normandie, Caen, France
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Murray L, Puls HT. Clinical guideline highlights for the hospitalist: Evaluation for bleeding disorders in suspected child abuse. J Hosp Med 2023. [PMID: 36751695 DOI: 10.1002/jhm.13050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/13/2023] [Accepted: 01/16/2023] [Indexed: 02/09/2023]
Abstract
Evaluation for Bleeding Disorders in Suspected Child Abuse RELEASE DATE: October 2022 PRIOR VERSION(S): 2013 DEVELOPER: American Academy of Pediatrics FUNDING SOURCE: American Academy of Pediatrics TARGET POPULATION: Children and infants with bruising or bleeding suspicious for physical abuse.
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Affiliation(s)
- Liza Murray
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Henry T Puls
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri, USA
- University of Missouri-Kansas City School of Medicine, Kansas City, Missouri, USA
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Anderst J, Carpenter SL, Abshire TC, Killough E, Mendonca EA, Downs SM, Wetmore C, Allen C, Dickens D, Harper J, Rogers ZR, Jain J, Warwick A, Yates A, Hord J, Lipton J, Wilson H, Kirkwood S, Haney SB, Asnes AG, Gavril AR, Girardet RG, Heavilin N, Gilmartin ABH, Laskey A, Messner SA, Mohr BA, Nienow SM, Rosado N, Idzerda SM, Legano LA, Raj A, Sirotnak AP, Forkey HC, Keeshin B, Matjasko J, Edward H, Chavdar M, Di Paola J, Leavey P, Graham D, Hastings C, Hijiya N, Hord J, Matthews D, Pace B, Velez MC, Wechsler D, Billett A, Stork L, Hooker R. Evaluation for Bleeding Disorders in Suspected Child Abuse. Pediatrics 2022; 150:189510. [PMID: 36180615 DOI: 10.1542/peds.2022-059276] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Bruising or bleeding in a child can raise the concern for child abuse. Assessing whether the findings are the result of trauma and/or whether the child has a bleeding disorder is critical. Many bleeding disorders are rare, and not every child with bruising/bleeding that may raise a concern for abuse requires an evaluation for bleeding disorders. However, in some instances, bleeding disorders can present in a manner similar to child abuse. Bleeding disorders cannot be ruled out solely on the basis of patient and family history, no matter how extensive. The history and clinical evaluation can be used to determine the necessity of an evaluation for a possible bleeding disorder, and prevalence and known clinical presentations of individual bleeding disorders can be used to guide the extent of laboratory testing. This clinical report provides guidance to pediatricians and other clinicians regarding the evaluation for bleeding disorders when child abuse is suspected.
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Affiliation(s)
- James Anderst
- Division of Child Adversity and Resilience, Children's Mercy Hospital, Department of Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City, Missouri
| | - Shannon L Carpenter
- Division of Hematology/Oncology/BMT, Children's Mercy Hospital, Department of Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City, Missouri
| | - Thomas C Abshire
- Senior Investigator Emeritus, Versiti Blood Research Institute, Department of Pediatrics, Medicine, and the CT SI of Southeast Wisconsin, Emeritus, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Emily Killough
- Division of Child Adversity and Resilience, Children's Mercy Hospital, Department of Pediatrics, University of Missouri Kansas City School of Medicine, Kansas City, Missouri
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