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
Telefon: +49 211 811-7665, -04052
Fax: +49 211 811-9293
eMail: Dirk.Klee@med.uni-duesseldorf.de
