Skip to main content
SpringerLink
Log in

Venous injury in pediatric abusive head trauma: a pictorial review

  • Child abuse imaging
  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

Abusive head trauma (AHT) is the leading cause of fatal head injuries in children younger than 2 years. An intracranial pathology can exist even in the setting of a normal physical exam. A delay in the diagnosis of AHT can have serious life-threatening consequences for the child and increases the potential the child will be abused again. In this article, we review the traumatic subdural hematoma as well as various morpho-structural patterns of shearing injuries and thrombosis of intracranial bridging veins. This work serves as a summary of patterns of imaging features of intracranial venous injury in AHT, as described in the literature, to facilitate familiarity and early detection of abusive head trauma in the pediatric population. Essentially, in AHT there is a traumatic injury to the bridging vein with either partial or complete tear. This can secondarily result in thrombosis at the terminal end of the bridging vein with blood clots adjacent to the bridging vein.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Choudhary AK, Servaes S, Slovis TL et al (2018) Consensus statement on abusive head trauma in infants and young children. Pediatr Radiol 48:1048–1065

    Article  Google Scholar 

  2. Choudhary AK, Bradford R, Dias MS et al (2015) Venous injury in abusive head trauma. Pediatr Radiol 45:1803–1813

    Article  Google Scholar 

  3. Christian CW, Block R, Jenny C et al (2009) Abusive head trauma in infants and children. Pediatrics 123:1409–1411

    Article  Google Scholar 

  4. Pfeifer CM, Hammer MR, Mangona KL, Booth TN (2017) Non-accidental trauma: the role of radiology. Emerg Radiol 24:207–213

    Article  Google Scholar 

  5. Rubin DM, Christian CW, Bilaniuk LT et al (2003) Occult head injury in high-risk abused children. Pediatrics 111:1382–1386

    Article  Google Scholar 

  6. Wright JN (2017) CNS injuries in abusive head trauma. AJR Am J Roentgenol 208:991–1001

    Article  Google Scholar 

  7. Fanconi M, Lips U (2010) Shaken baby syndrome in Switzerland: results of a prospective follow-up study, 2002-2007. Eur J Pediatr 169:1023–1028

    Article  Google Scholar 

  8. Kemp A, Jaspan T, Griffiths J et al (2011) Neuroimaging: what neuroradiological features distinguish abusive from non-abusive head trauma? A systematic review. Arch Dis Child 96:1103–1112

    Article  CAS  Google Scholar 

  9. Miller JD, Nader R (2014) Acute subdural hematoma from bridging vein rupture: a potential mechanism for growth: clinical article. J Neurosurg 120:1378–1384

    Article  Google Scholar 

  10. Hahnemann ML, Kinner S, Schweiger B et al (2015) Imaging of bridging vein thrombosis in infants with abusive head trauma: the “tadpole sign”. Eur Radiol 25:299–305

    Article  Google Scholar 

  11. Adamsbaum C, Rambaud C (2012) Abusive head trauma: don’t overlook bridging vein thrombosis. Pediatr Radiol 42:1298–1300

    Article  Google Scholar 

  12. Rambaud C (2015) Bridging veins and autopsy findings in abusive head trauma. Pediatr Radiol 45:1126–1131

    Article  Google Scholar 

  13. Yamashima T, Friede RL (1984) Why do bridging veins rupture into the virtual subdural space? J Neurol Neurosurg Psychiatry 47:121–127

    Article  CAS  Google Scholar 

  14. Nierenberger M, Wolfram-Gabel R, Decock-Catrin S et al (2013) Investigation of the human bridging veins structure using optical microscopy. Surg Radiol Anat 35:331–337

    Article  Google Scholar 

  15. Bradford R, Choudhary AK, Dias MS (2013) Serial neuroimaging in infants with abusive head trauma: timing abusive injuries — clinical article. J Neurosurg Pediatr 12:110–119

    Article  Google Scholar 

  16. Hedlund GL (2012) Subdural hemorrhage in abusive head trauma: imaging challenges and controversies. J Am Osteopat Coll Radiol 1:23–30

    Google Scholar 

  17. Vezina G (2009) Assessment of the nature and age of subdural collections in nonaccidental head injury with CT and MRI. Pediatr Radiol 39:586–590

    Article  Google Scholar 

  18. Joy HM, Anscombe AM, Gawne-Cain ML (2007) Blood-stained, acute subdural hygroma mimicking a subacute subdural haematoma in non-accidental head injury. Clin Radiol 62:703–706

    Article  CAS  Google Scholar 

  19. Offiah C, Forbes WSC, Thorne J (2006) Non-haemorrhagic subdural collection complicating rupture of a middle cranial fossa arachnoid cyst. Br J Radiol 79:79–82

    Article  CAS  Google Scholar 

  20. Wittschieber D, Karger B, Niederstadt T et al (2015) Subdural hygromas in abusive head trauma: pathogenesis, diagnosis, and forensic implications. AJNR Am J Neuroradiol 36:432–439

    Article  CAS  Google Scholar 

  21. Vázquez E, Delgado I, Sánchez-Montañez A et al (2014) Imaging abusive head trauma: why use both computed tomography and magnetic resonance imaging? Pediatr Radiol 44:S589–S603

    Article  Google Scholar 

  22. Datta S, Stoodley N, Jayawant S et al (2005) Neuroradiological aspects of subdural haemorrhages. Arch Dis Child 90:947–951

    Article  CAS  Google Scholar 

  23. Kemp AM, Rajaram S, Mann M et al (2009) What neuroimaging should be performed in children in whom inflicted brain injury (iBI) is suspected? A systematic review. Clin Radiol 64:473–483

    Article  CAS  Google Scholar 

  24. Sieswerda-Hoogendoorn T, Postema FAM, Verbaan D et al (2014) Age determination of subdural hematomas with CT and MRI: a systematic review. Eur J Radiol 83:1257–1268

    Article  Google Scholar 

  25. Norman MG, Smialek JE, Newman DE, Horembala EJ (1984) The postmortem examination on the abused child. Pathological, radiographic, and legal aspects. Perspect Pediatr Pathol 8:313–343

    CAS  PubMed  Google Scholar 

  26. Maxeiner H (1997) Detection of ruptured cerebral bridging veins at autopsy. Forensic Sci Int 89:103–110

    Article  CAS  Google Scholar 

  27. Maxeiner H (2001) Demonstration and interpretation of bridging vein ruptures in cases of infantile subdural bleedings. J Forensic Sci 46:85–93

    Article  CAS  Google Scholar 

  28. Ehrlich E, Maxeiner H, Lange J (2003) Postmortem radiological investigation of bridging vein ruptures. Legal Med 5:225–227

    Article  Google Scholar 

  29. Stein KM, Ruf K, Ganten MK, Mattern R (2006) Representation of cerebral bridging veins in infants by postmortem computed tomography. Forensic Sci Int 163:93–101

    Article  Google Scholar 

  30. Depreitere B, Van Lierde C, Vander Sloten J et al (2006) Mechanics of acute subdural hematomas resulting from bridging vein rupture. J Neurosurg 104:950–956

    Article  Google Scholar 

  31. Han H, Tao W, Zhang M (2007) The dural entrance of cerebral bridging veins into the superior sagittal sinus: an anatomical comparison between cadavers and digital subtraction angiography. Neuroradiology 49:169–175

    Article  Google Scholar 

  32. Monea AG, Baeck K, Verbeken E et al (2014) The biomechanical behaviour of the bridging vein–superior sagittal sinus complex with implications for the mechanopathology of acute subdural haematoma. J Mech Behav Biomed Mater 32:155–165

    Article  Google Scholar 

  33. Barlow KM, Gibson RJ, McPhillips M, Minns RA (1999) Magnetic resonance imaging in acute non-accidental head injury. Acta Paediatr 88:734–740

    Article  CAS  Google Scholar 

  34. Yilmaz U, Körner H, Meyer S, Reith W (2015) Multifocal signal loss at bridging veins on susceptibility-weighted imaging in abusive head trauma. Clin Neuroradiol 25:181–185

    Article  CAS  Google Scholar 

  35. Zuccoli G, Khan AS, Panigrahy A, Tamber MS (2017) In vivo demonstration of traumatic rupture of the bridging veins in abusive head trauma. Pediatr Neurol 72:31–35

    Article  Google Scholar 

  36. Leach JL, Fortuna RB, Jones BV, Gaskill-Shipley MF (2006) Imaging of cerebral venous thrombosis: current techniques, spectrum of findings, and diagnostic pitfalls. Radiographics 26:S19–S41

    Article  Google Scholar 

  37. Ferro JM, Morgado C, Sousa R, Canhão P (2007) Interobserver agreement in the magnetic resonance location of cerebral vein and dural sinus thrombosis. Eur J Neurol 14:353–356

    Article  CAS  Google Scholar 

  38. Klingebiel R, Bauknecht HC, Bohner G et al (2007) Comparative evaluation of 2D time-of-flight and 3D elliptic centric contrast-enhanced MR venography in patients with presumptive cerebral venous and sinus thrombosis. Eur J Neurol 14:139–143

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, University of Arkansas for Medical Sciences, 4301 W. Markham St., Slot 556, Little Rock, AR, 72205, USA

    George Koshy Vilanilam, Sateesh Jayappa, Raghu H. Ramakrishnaiah & Arabinda K. Choudhary

  2. Department of Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Shivang Desai

  3. The NDRD (Program for the Study in Neurodevelopment in Rare Disorders), University of Pittsburgh, Pittsburgh, PA, USA

    Giulio Zuccoli

Authors
  1. George Koshy Vilanilam
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sateesh Jayappa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shivang Desai
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Giulio Zuccoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Raghu H. Ramakrishnaiah
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Arabinda K. Choudhary
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to George Koshy Vilanilam.

Ethics declarations

Conflicts of interest

None

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Vilanilam, G.K., Jayappa, S., Desai, S. et al. Venous injury in pediatric abusive head trauma: a pictorial review. Pediatr Radiol 51, 918–926 (2021). https://doi.org/10.1007/s00247-021-05016-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00247-021-05016-9

Keywords

Search

Navigation