Spinal subdural effusion - an additional sonographic sign of child abuse.

[child syndrome]

To assess the suitability of spinal ultrasound for the detection of spinal subdural hematoma in infants with sustained non-accidental trauma .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 .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 .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 .