Postmortem Radiography After Unexpected Death in Neonates, Infants, and Children: Should Imaging Be Routine?
Elizabeth P. McGraw1,
John E. Pless2,
Debra J. Pennington3 and
Susan J. White4
1 Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC
27710.
2 Department of Pathology and Laboratory Medicine, Indiana University Medical
Center, Medical Science 157, Indianapolis, IN 46202.
3 Austin Radiological Association, 6101 W. Courtyard Dr., Bldg. 5, Austin, TX
78730.
4 Clinical Diagnostic Radiology Associates, 1300 N. 12th St., Phoenix, AZ
85006.
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Fig. 1. —Flowchart of all child abuse deaths (n = 14) from
106 consecutive cases shows seven patients had fractures present on postmortem
radiography. Six (43%) of 14 patients had fractures of both appendicular and
axial skeleton. One (7%) of 14 patients had fractures involving only axial
skeleton. Seven (50%) of 14 abuse victims had no skeletal survey findings.
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Fig. 2. —Diagram of infant skeleton reveals specific sites and total
number of all extremity fractures detected on postmortem radiography in abuse
victims. All fractures were classic metaphyseal lesions, which are associated
with high index of suspicion of abuse, except two fractures that involved
proximal right tibial diaphysis in one infant and left distal radial diaphysis
in another infant. In two infants with these fractures, classic metaphyseal
fractures were also present in other extremities. R = right.
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Fig. 3A. —11-week-old male infant with blunt force injuries of chest
and abdomen. Extremity fractures and healed rib fractures were detected only
on postmortem radiography. Acute rib fractures were revealed both at autopsy
and on postmortem radiography. Anteroposterior radiograph of right distal
femur shows corner fracture (classic metaphyseal lesion) of distal right
medial femoral metaphysis (arrow).
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Fig. 3B. —11-week-old male infant with blunt force injuries of chest
and abdomen. Extremity fractures and healed rib fractures were detected only
on postmortem radiography. Acute rib fractures were revealed both at autopsy
and on postmortem radiography. Anteroposterior radiograph of distal right
tibia shows classic metaphyseal fracture of distal right tibial metaphysis
(arrow).
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Fig. 3C. —11-week-old male infant with blunt force injuries of chest
and abdomen. Extremity fractures and healed rib fractures were detected only
on postmortem radiography. Acute rib fractures were revealed both at autopsy
and on postmortem radiography. Anteroposterior radiograph of distal left
femoral metaphysis shows classic metaphyseal fracture of distal left medial
femoral metaphysis (arrow).
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Fig. 3D. —11-week-old male infant with blunt force injuries of chest
and abdomen. Extremity fractures and healed rib fractures were detected only
on postmortem radiography. Acute rib fractures were revealed both at autopsy
and on postmortem radiography. Anteroposterior radiograph of chest reveals
fractures with callus formation of right lateral third and fourth ribs and
right posterior ninth ribs (large arrows). Note acute fractures
involving left posterior third, fourth, seventh, eighth, and ninth ribs
(arrowheads) and left lateral sixth and seventh ribs (small
arrows). Endotracheal tube terminates in distal trachea. Gastric
dilatation resulted from resuscitative efforts at scene before intubation.
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Fig. 4A. —5-week-old female infant with multiple blunt force injuries
of chest and abdomen and shaking injury of head (recent and remote subdural
hemorrhage found at autopsy). These extremity fractures were detected on
postmortem skeletal survey. Victim's father was convicted of murder and her
mother was charged with neglect. Posteroanterior radiograph of left wrist
reveals transverse fracture of distal left radial diaphysis and corner
fracture of distal left ulnar metaphysis (arrows).
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Fig. 4B. —5-week-old female infant with multiple blunt force injuries
of chest and abdomen and shaking injury of head (recent and remote subdural
hemorrhage found at autopsy). These extremity fractures were detected on
postmortem skeletal survey. Victim's father was convicted of murder and her
mother was charged with neglect. Posteroanterior radiograph of right wrist
shows classic metaphyseal fracture of distal right ulna (arrow).
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Fig. 4C. —5-week-old female infant with multiple blunt force injuries
of chest and abdomen and shaking injury of head (recent and remote subdural
hemorrhage found at autopsy). These extremity fractures were detected on
postmortem skeletal survey. Victim's father was convicted of murder and her
mother was charged with neglect. Anteroposterior radiograph of left tibia and
fibula show classic metaphyseal fractures of proximal and distal left tibia
(arrows).
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Copyright © 2002 by the American Roentgen Ray Society.
