Sentinel Injuries: It’s What’s Inside That Counts

This chapter of the What Do I Do Now series on Pediatric Radiology discusses the indicated approach to imaging when evaluating an infant when there is a suspicion for physical abuse. The chapter addresses when clinicians should be concerned for abusive injuries, regardless of the provided history. The chapter reviews and discusses the mechanism of the most commonly seen inflicted injuries, including classic metaphyseal lesions (CML), rib fractures, and subdural hematomas (SDH). It also reviews the most commonly conducted imaging studies to identify inflicted injuries, including head computed tomography (CT) scans and skeletal surveys as recommended by the American College of Radiology and the American Academy of Pediatrics.