CT chest without contrast CT of the chest is more sensitive than chest radiography in detection of rib fractures; chest radiography defines only about 60% of the fractures that are detected by CT [46]. Anterior and posterior fractures are better seen by CT, as are bilateral fractures. However, the need for sedation in noncooperative children makes this test a useful adjunct rather than a first-line test in the imaging workup of nonaccidental trauma (NAT). A reduced-dose chest CT may detect rib fractures in infants with high suspicion for NAT and a normal initial 4-view chest, with a sub- millisievert radiation dose equaling twice that of a 4-view chest [47]. Multiplanar reformatted images may aid in rib fracture detection [48]. In addition, chest CT may detect scapular and spine fractures not evident on skeletal survey [47]. CT chest with contrast A CT scan of the chest with intravenous (IV) contrast is reserved for children with clinical suspicion of intrathoracic traumatic injury. IV contrast allows for detection of vascular injuries. CT abdomen and pelvis with contrast CT of the abdomen and pelvis with IV contrast is utilized for children with suspected intra-abdominal and/or intrapelvic injury [49]. Portal venous phase imaging is most helpful for detecting solid-organ injury. Delayed excretory-phase imaging may be useful in a few selected cases when imaging findings suggest disruption of the genitourinary tract. Noncontrast abdominal CT is not recommended. The need for oral contrast is at the discretion of the radiologist, and its use may be considered when there is concern for duodenal hematoma [23]. Tc-99m bone scan whole body Bone scintigraphy is a complementary/adjunctive examination for detecting bone injuries [28,29] but is usually not considered an alternative to skeletal survey. It should be used when the radiographic skeletal survey is negative but clinical suspicion remains high and search for further evidence of skeletal trauma is warranted.
Suspected Physical Abuse Child. CT chest without contrast CT of the chest is more sensitive than chest radiography in detection of rib fractures; chest radiography defines only about 60% of the fractures that are detected by CT [46]. Anterior and posterior fractures are better seen by CT, as are bilateral fractures. However, the need for sedation in noncooperative children makes this test a useful adjunct rather than a first-line test in the imaging workup of nonaccidental trauma (NAT). A reduced-dose chest CT may detect rib fractures in infants with high suspicion for NAT and a normal initial 4-view chest, with a sub- millisievert radiation dose equaling twice that of a 4-view chest [47]. Multiplanar reformatted images may aid in rib fracture detection [48]. In addition, chest CT may detect scapular and spine fractures not evident on skeletal survey [47]. CT chest with contrast A CT scan of the chest with intravenous (IV) contrast is reserved for children with clinical suspicion of intrathoracic traumatic injury. IV contrast allows for detection of vascular injuries. CT abdomen and pelvis with contrast CT of the abdomen and pelvis with IV contrast is utilized for children with suspected intra-abdominal and/or intrapelvic injury [49]. Portal venous phase imaging is most helpful for detecting solid-organ injury. Delayed excretory-phase imaging may be useful in a few selected cases when imaging findings suggest disruption of the genitourinary tract. Noncontrast abdominal CT is not recommended. The need for oral contrast is at the discretion of the radiologist, and its use may be considered when there is concern for duodenal hematoma [23]. Tc-99m bone scan whole body Bone scintigraphy is a complementary/adjunctive examination for detecting bone injuries [28,29] but is usually not considered an alternative to skeletal survey. It should be used when the radiographic skeletal survey is negative but clinical suspicion remains high and search for further evidence of skeletal trauma is warranted.