title: Characterization of bruises using ultrasonography for potential application in diagnosis of child abuse.
abstract: To protect children from abuse, it is important to identify victims at an early date, but diagnosis is often difficult. We used ultrasonography for objective examination of bruises arising from subcutaneous hemorrhages, and determined whether we could precisely measure the depth and thickness of a subcutaneous hemorrhage. We compared macroscopic findings, microscopic findings and ultrasonographic images of 10 bruises in forensic autopsy cases. In addition, we measured chronologic changes in subcutaneous hemorrhages using ultrasonography of 16 bruises in healthy volunteer children. Mild or moderate subcutaneous hemorrhages spreading along the fibrous partition in subcutaneous fatty tissue were observed by histological examination. There was a thickened fibrous partition or an isoechoic or hyperechoic area in the ultrasonographic images. A good correlation between the thickness of the subcutaneous hemorrhages by macroscopic examination and by ultrasonographic imaging was found in postmortem cases. We were also able to confirm objectively that the thickness of the subcutaneous hemorrhage of healthy children decreased with time. It is possible to measure the depth from the skin surface to the subcutaneous hemorrhage, and the thickness of the subcutaneous hemorrhage accurately using ultrasonography. Thus, the age of a bruise can be estimated more precisely using information on the subcutaneous hemorrhage from ultrasonography in addition to established evaluations by the naked eye and by spectrophotometry.
authors.affiliation: Department of Forensic Sciences, Akita University Graduate School of Medicine, Hondo 1-1-1, Akita 010-8543, Japan. mimasaka@med.akita-u.ac.jp
authors.forename: Sohtaro
authors.initials: S
authors.lastname: Mimasaka
authors.forename: Toru
authors.initials: T
authors.lastname: Oshima
authors.forename: Maki
authors.initials: M
authors.lastname: Ohtani
mesh_terms: D000328:Adult; D000368:Aged; D002648:Child; D002649:Child Abuse / Q000175:diagnosis*; D002675:Child, Preschool; D003288:Contusions / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D049429:Forensic Pathology / Q000379:methods; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D012871:Skin Diseases / Q000000981:diagnostic imaging / Q000473:pathology; D013053:Spectrophotometry; D014463:Ultrasonography; D055815:Young Adult