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Radiologie up2date 2011; 11(4): 315-333
DOI: 10.1055/s-0030-1256877
Pädiatrische Radiologie

© Georg Thieme Verlag KG Stuttgart · New York

Kindesmisshandlung: Nicht akzidentelle Kopfverletzungen

Child abuse: non-accidental head injuryD.  Klee, J.  Schaper
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Publication Date:
16 December 2011 (online)

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Zusammenfassung

Die Kenntnis der Verletzungsmuster bei Kindesmisshandlung schützt das Kind vor einer weiteren Misshandlung und damit vor weiteren auch lebensbedrohlichen Schädigungen der körperlichen Integrität.

Neben den klinischen Aspekten müssen durch den Radiologen typische Verletzungsmuster des Skelettsystems, der Organe und der intrakraniellen Strukturen erkannt und wenn möglich zeitlich eingeordnet werden.

Die durchzuführenden diagnostischen Maßnahmen erfolgen nach festgelegten Leitlinien und die Beurteilung muss verschiedene Kriterien berücksichtigen. Diese werden in diesem Artikel dargestellt.

Die Diagnose einer Kindesmisshandlung sollte im Zweifelsfall verifiziert werden, indem ein bei Kindesmisshandlungen erfahrener Radiologe/Kinderradiologe die Bilder zweitbefundet.

Abstract

Knowledge of the radiological appearances that are the result of child abuse is an integral part of prevention of further, potentially life-threatening, injury. Radiologists must have un understanding of typical injury patterns of the skeletal system, visceral and intra-cranial structures, which should ideally be ordered chronologically. Necessary radiological investigations follow guidelines with specific criteria that are pointed out in this review. In equivocal cases of abuse, the opinion of a second (paediatric) radiologist should be sought.

Keywords

Non accidentell head injury - NAHI - child abuse

Kernaussagen

  • Bei der Kindesmisshandlung haben körperliche Gewalt und dabei insbesondere die nicht akzidentellen Kopfverletzungen (non-accidental head injury [NAHI]) eine große Bedeutung. Bei den NAHI kommen Frakturen, extraaxiale Blutungen und Parenchymverletzungen vor. Die Schädigungen können tödlich sein.

  • Neben den klinischen Aspekten müssen durch den Radiologen typische Verletzungsmuster des Skelettsystems, der Organe und der intrakraniellen Strukturen erkannt und wenn möglich zeitlich eingeordnet werden.

  • Einzeln stehende, bildmorphologisch absolut eindeutige Kriterien, die eine NAHI beweisen, d. h. von einer akzidentellen Kopfverletzung abgrenzen, gibt es nicht. Die Diagnose der NAHI ergibt sich aus der Befundkonstellation.

  • Beim Verdacht auf eine Kindesmisshandlung ist eine Bildgebung des Kopfes bei Kindern < 2 Jahren immer indiziert, da geringe zerebrale Verletzungen bei misshandelten Kindern nicht immer neurologisch offensichtlich sind. Die einzelnen Modalitäten für die Kopfuntersuchung sind in Abhängigkeit vom Alter und der klinischen Symptomatik durchzuführen.

  • Alter und Lokalisation einer intrakraniellen Verletzung sind wichtige Kriterien, die in die radiologische Beurteilung mit aufgenommen werden müssen. Wichtig ist auch noch die Beantwortung der Frage, ob es sich um ein einzeitiges oder mehrzeitiges Ereignis handelt.

  • Im Zweifellsfall und in Abhängigkeit von den lokalen Gegebenheiten sollte der Radiologe einen Kinderradiologen oder einen anderen in diesem Thema versierten radiologischen Kollegen konsiliarisch hinzuziehen.

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Dr. med. Dirk Klee

Universitätsklinikum Düsseldorf
Kinderradiologie des Instituts für Diagnostische und Interventionelle Radiologie

Moorenstr. 5
40225 Düsseldorf

Phone: +49 211 811-7665, -04052

Fax: +49 211 811-9293

Email: Dirk.Klee@med.uni-duesseldorf.de