Forensic pediatric radiology: studies in living and deceased children

Radiology is an important tool in establishing the diagnosis of physical abuse, as one can objectively depict fractures or internal injuries. In this thesis we have tried to provide some insight into the possibilities and impossibilities of (forensic) pediatric radiology in establishing a diagnosis of physical child abuse, in both living (part 1) and deceased (part 2) children. In the first part we have given an overview of imaging techniques in child abuse, risk factors for and radiological aspects of abusive head trauma. Furthermore we have found that there is no radiological difference between children with and without evidence for impact trauma and we have performed a survey among radiologists and systematic literature search regarding the possibility of age determination of subdural hematomas based on imaging findings, which we found to be unreliable. With a case report describing a fracture that is known to be associated with abuse, but was caused by vaginal breech delivery in this case, we underline the need for a differential diagnosis. In the second part of the thesis, we describe the current techniques and normal findings in postmortem imaging. We have determined the concordance between causes of death determined by a radiologist versus pathologist, which was lower than expected. Furthermore we describe the additional value of postmortem CT in neonaticide with delayed finding of the body, causing severe decomposition changes. Finally, we present a case report illustrating one of the additional
values of postmortem CT compared to autopsy, by demonstrating the presence of air which was not found with autopsy. In conclusion, postmortem CT can be used as an adjunct to an autopsy, but cannot be used as a replacement yet.