Spinal Subdural Effusion – An Additional Sonographic Sign of Child Abuse

Zusammenfassung

Ziel: Es wurde die Aussagekraft des spinalen Ultraschalls zur Detektion von spinalen Subduralergüssen bei Säuglingen mit Schütteltrauma untersucht. Material und Methoden: Sechs stationär aufgenommene Säuglinge (mittleres Alter ± SD 3,3 ± 1,5 Monate) mit Verdacht auf Kindesmisshandlung wurden mittels Ultraschall, CT und/oder MRI und Skelettröntgen untersucht. Zwölf gesunde Säuglinge (mittleres Alter ± SD 2,5 ± 1,4 Monate), bei welchen ein spinaler Ultraschall zum Ausschluss des Vorliegens von spinalen Dysrhaphien durchgeführt wurde, dienten als Kontrollgruppe. Ergebnisse: Bei allen sechs Säuglingen, die ein Schütteltrauma erlitten hatten, wurde mittels Ultraschall und CT oder MRI ein kraniales subdurales Hämatom festgestellt. Mittels spinalem Ultraschall konnte bei allen sechs Säuglingen eine spinale subdurale echogene Flüssigkeitsansammlung mit beweglichen Partikeln dargestellt werden, welche die undulierende Arachnoidea von der Dura mater spinalis separierte. Die spinalen subduralen Ergüsse zeigten eine unterschiedliche kraniokaudale Ausdehnung und variable Tiefe in der Axialebene. Die Dura und Arachnoidea mater spinalis konnten sonografisch identifiziert werden und bestätigten die subdurale Lokalisation des Hämatoms. Keiner der Säuglinge der Kontrollgruppe zeigte eine spinale subdurale Flüssigkeitsansammlung. Schlussfolgerung: Das Vorhandensein eines spinalen Subduralergusses ist ein wertvolles zusätzliches Zeichen der Kindesmisshandlung, welches rasch mittels spinalem Ultraschall ohne die Notwendigkeit einer Sedierung festgestellt werden kann. Der spinale Ultraschall sollte daher zusätzlicher Bestandteil der bildgebenden Diagnostik bei Verdacht auf Kindesmisshandlung sein.

Abstract

Purpose: To assess the suitability of spinal ultrasound for the detection of spinal subdural hematoma in infants with sustained non-accidental trauma. Materials and Methods: Six infants (mean age ± SD 3.3 ± 1.5 months) admitted to our hospital because of suspected non-accidental trauma were examined radiologically with ultrasound, CT and/or MRI and skeletal radiography. Twelve healthy infants (mean age ± SD 2.5 ± 1.4 months) in whom an ultrasound of the spine was performed to exclude spinal dysraphism served as controls. Results: All six patients with non-accidental trauma (NAT) presented with cranial subdural hematoma visualized by ultrasound and CT scan or MRI. Spinal ultrasound detected echogenic effusions with floating particles that displaced the undulating arachnoidea from the dura mater spinalis in all six patients with NAT. The size of the spinal subdural hematoma varied and extended from the cervical spine to the cauda equina. The anatomic landmarks (dura mater spinalis, arachnoidea spinalis) were identified and confirmed the subdural location. All spinal subdural hematomas were asymptomatic and detected by diagnostic ultrasound. None of the infants had a pre-existing neurological or hemorrhagic disorder. The plain X-rays of the spine in these infants showed no osseous lesion. Spinal subdural hematoma was not observed in any of the controls. Conclusion: The presence of spinal subdural hematoma is a valuable sign of sustained non-accidental trauma in infants that can be quickly and easily detected using spinal ultrasound without the need for sedation or general anesthesia. Thus, spinal ultrasound should be part of the imaging examinations performed in infants with suspected abuse.

Key words

infants, injuries - ultrasound - spinal canal

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