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Imaging of bridging vein thrombosis in infants with abusive head trauma: the “Tadpole Sign”.

  • Pediatric
  • Published:
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Abstract

Objectives

Abusive head trauma (AHT) in infants is usually diagnosed using a multi-disciplinary approach by investigating the circumstances and identifying morphological indicators, for example, subdural hematomas (SDHs), subdural hygromas (SDHys), retinal haemorrhages and encephalopathy. The present morphological study investigates the incidence, radiological characteristics and non-radiological co-factors of bridging vein thrombosis (BVT) in infants with AHT.

Methods

From 2002 to 2013, computed tomography (CT) and magnetic resonance imaging (MRI) material of 628 infants aged 0-2 years were analysed retrospectively. If available, medicolegal expert opinions were additionally considered. Cases with SDHs and/or SDHys were identified and systematically evaluated as to the presence and characteristics of BVT.

Results

SDHs and/or SDHys were present in 29 of the 81 cases exhibiting morphological abnormalities in the initial CT. Among these, 11 cases (40 %) had BVT (mean age = 5.0 months). BVT could be best depicted in the T1-weighted spin echo and T2*/susceptibility-weighted MRI. In one case, BVT could be depicted indirectly using time-of-flight MR venography. The predominant (73 %) BVT shape was found to be tadpole-like (“Tadpole Sign”).

Conclusions

In the absence of appropriate accidental trauma, BVT appears to be a strong indicator of AHT. Therefore, the BVT/Tadpole Sign represents compelling cause to search for other signs of AHT.

Key points

• BVT is an excellent indicator of AHT in SDH/SDHy cases.

• Accidental trauma must be ruled out before diagnosing AHT.

• The Tadpole Sign appears to be the most characteristic shape of BVT.

• BVT can be depicted using CT, MRI and MR venography.

• The Tadpole Sign suggests searching for other signs of AHT.

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Abbreviations

AHT:

Abusive head trauma

SBS:

Shaken baby syndrome

SDH:

Subdural hematoma

SDHy:

Subdural hygroma

BV:

Bridging vein

BVT:

Bridging vein thrombosis

CT:

Computed tomography

MRI:

Magnetic resonance imaging

RH:

Retinal haemorrhages

CCI:

Craniocerebral injury

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Acknowledgments

The scientific guarantor of this publication is Daniel Wittschieber, MD. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional Review Board approval was obtained. Written informed consent was obtained from all subjects (patients) in this study. Approval from the institutional animal care committee was not required because the study did not use any animals. No study subjects or cohorts have been reported previously. Methodology: retrospective, diagnostic study / observational study, performed at one institution.

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Authors and Affiliations

  1. Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany

    Maria L. Hahnemann, Sonja Kinner & Bernd Schweiger

  2. Institute of Legal Medicine, University Hospital Essen, Hufelandstraße 55, 45147, Essen, Germany

    Thomas Bajanowski

  3. Institute of Legal Medicine, University Hospital Münster, Röntgenstraße 23, 48149, Münster, Germany

    Bernd Karger, Heidi Pfeiffer & Daniel Wittschieber

Authors
  1. Maria L. Hahnemann
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  2. Sonja Kinner
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  3. Bernd Schweiger
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  4. Thomas Bajanowski
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  5. Bernd Karger
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  6. Heidi Pfeiffer
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  7. Daniel Wittschieber
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Correspondence to Daniel Wittschieber.

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Hahnemann, M.L., Kinner, S., Schweiger, B. et al. Imaging of bridging vein thrombosis in infants with abusive head trauma: the “Tadpole Sign”. . Eur Radiol 25, 299–305 (2015). https://doi.org/10.1007/s00330-014-3443-z

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  • DOI: https://doi.org/10.1007/s00330-014-3443-z

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