Subdural haematomas of different ages or over the convexities and interhemispheric fissure, with hypoxic-ischaemic injury, bridging vein thrombosis and retinal haemorrhages, without an adequate history — the report describes, dates cautiously and triggers the safeguarding pathway and skeletal survey.
Orient first
- The radiologist reports findings and their consistency with the history; does not assign guilt.
- Mixed-density subdural collections can occur in a single event — dating is imprecise (verify current consensus).
- Benign enlargement of the subarachnoid spaces can be associated with small subdurals — context matters.
Acquire the study
- Non-contrast CT head, thin slices, bone window and 3D skull reconstruction.
The manoeuvre
- Subdural collections: convexity, interhemispheric, posterior fossa; their densities.
- Bone window and 3D: skull fractures (complex, bilateral, crossing sutures).
- Hypodense parenchyma with loss of grey–white differentiation (hypoxic-ischaemic injury).
- Scalp swelling as a sign of impact.
What confirms it
- A pattern of injuries inconsistent with the history, assessed with the multidisciplinary safeguarding team.
What licenses you to exclude it
- Imaging cannot exclude abuse; normal imaging with concerning history still warrants the pathway.
The classic misread
- Calling a normal suture or a vascular channel a fracture on 2D only.