Noncontrast CT of the abdomen is not adequately sensitive in detection of intrathoracic or intra-abdominal trauma. Routine CT scan screening for abdominal or chest injury is not recommended [72]. CT of the chest Injuries to the chest (other than the ribs) are uncommon and include hemopericardium, cardiac contusions and lacerations, pleural effusion, and lung contusions [23,64,77,81]. Contrast-enhanced CT of the chest is indicated in acute evaluation of the child with these types of suspected nonskeletal intrathoracic injury; noncontrast CT of the chest is not adequately sensitive. Routine CT scan screening for chest injury is not recommended [72]. In children <24 months of age, a repeat skeletal survey performed approximately 2 weeks after the initial examination can detect fractures not seen on initial skeletal survey, can clarify equivocal findings, and can provide information on the age of child abuse fractures [22,26,83]. Nine to 12% of infants have healing fractures on follow-up survey after a negative initial survey [82,84], and up to one-third of follow-up surveys yield new information [84]. Half to three-fourths of these newly detected fractures are rib fractures [26,82,84]; classic metaphyseal lesions are the second most common [83]. As such, many authors have suggested a more limited follow-up skeletal survey, as described above. However, it is not possible to exactly date fractures by radiography [27]. Tc-99m bone scan whole body In selected cases, when it is not possible to wait 2 weeks for a follow-up skeletal survey radiograph, a bone scan can be considered. Bone scan is sensitive in detecting radiographically occult fractures. It is particularly useful in detection of fractures of the ribs, scapula, spine, and pelvis [30]. It is not sensitive, however, in the detection of skull fractures [29]. Metaphyseal injury may be difficult to see because of the adjacent normal metabolically active physis. Radiation exposure is higher than a skeletal survey [29].
Suspected Physical Abuse Child. Noncontrast CT of the abdomen is not adequately sensitive in detection of intrathoracic or intra-abdominal trauma. Routine CT scan screening for abdominal or chest injury is not recommended [72]. CT of the chest Injuries to the chest (other than the ribs) are uncommon and include hemopericardium, cardiac contusions and lacerations, pleural effusion, and lung contusions [23,64,77,81]. Contrast-enhanced CT of the chest is indicated in acute evaluation of the child with these types of suspected nonskeletal intrathoracic injury; noncontrast CT of the chest is not adequately sensitive. Routine CT scan screening for chest injury is not recommended [72]. In children <24 months of age, a repeat skeletal survey performed approximately 2 weeks after the initial examination can detect fractures not seen on initial skeletal survey, can clarify equivocal findings, and can provide information on the age of child abuse fractures [22,26,83]. Nine to 12% of infants have healing fractures on follow-up survey after a negative initial survey [82,84], and up to one-third of follow-up surveys yield new information [84]. Half to three-fourths of these newly detected fractures are rib fractures [26,82,84]; classic metaphyseal lesions are the second most common [83]. As such, many authors have suggested a more limited follow-up skeletal survey, as described above. However, it is not possible to exactly date fractures by radiography [27]. Tc-99m bone scan whole body In selected cases, when it is not possible to wait 2 weeks for a follow-up skeletal survey radiograph, a bone scan can be considered. Bone scan is sensitive in detecting radiographically occult fractures. It is particularly useful in detection of fractures of the ribs, scapula, spine, and pelvis [30]. It is not sensitive, however, in the detection of skull fractures [29]. Metaphyseal injury may be difficult to see because of the adjacent normal metabolically active physis. Radiation exposure is higher than a skeletal survey [29].