J Korean Ophthalmol Soc.  2017 Nov;58(11):1313-1316. 10.3341/jkos.2017.58.11.1313.

Smartphone Fundus Photography in an Infant with Abusive Head Trauma

• Kim YH
• Choi SY
• Lee JS
• Yoon SH
• Chung SA

• KMID: 2395876
• DOI: http://doi.org/10.3341/jkos.2017.58.11.1313

Abstract

PURPOSE
To report fundus photography using a smartphone in an infant with abusive head trauma.
CASE SUMMARY
An 8-month-old male infant presented to the emergency room with decreased consciousness and epileptic seizures that the parents attributed to a fall from a chair. He had no external wounds or fractures to the skull or elsewhere. However, computerized tomography of the brain revealed an acute subdural hematoma in the right cranial convexity and diffuse cerebral edema, leading to a midline shift to the left and effacement of the right lateral ventricle and basal cistern. The attending neurosurgeon promptly administered a decompressive craniectomy. Immediately after the emergency surgery, a fundus examination revealed numerous multi-layered retinal hemorrhages in the posterior pole extending to the periphery in each eye. He also had white retinal ridges with cherry hemorrhages in both eyes. We acquired retinal photographs using the native camera of a smartphone in video mode. The photographer held the smartphone with one hand, facing the patient's eye at 15-20 cm, and held a 20 diopter condensing lens at 5 cm from the eye in the other hand. Our documentation using a smartphone led to a diagnosis of abusive head trauma and to obtain the criminal's confession, because the findings were specific for repetitive acceleration-deceleration forces to an infant`s eye with a strong vitreoretinal attachment.
CONCLUSIONS
This ophthalmic finding had a key role in the diagnosis of abusive head trauma. This case presented the diagnostic use of a smartphone for fundus photography in this important medicolegal case.

Keyword

Abusive head trauma; Retinal hemorrhages; Shaken baby syndrome; Smartphone fundus photography

MeSH Terms

Brain
Brain Edema
Consciousness
Craniocerebral Trauma*
Decompressive Craniectomy
Diagnosis
Emergencies
Emergency Service, Hospital
Epilepsy
Hand
Head*
Hematoma, Subdural, Acute
Hemorrhage
Humans
Infant*
Lateral Ventricles
Male
Neurosurgeons
Parents
Photography*
Retinal Hemorrhage
Retinaldehyde
Shaken Baby Syndrome
Skull
Smartphone*
Wounds and Injuries
Retinaldehyde

Figure

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  Figure 1. Clinical photography, computed tomography (CT) scan of the brain, smartphone photographs of the fundus, and cross-section of gross examination on autopsy. (A) Absence of external signs of ocular trauma, but presence of a pale-blue eyelid margin. (B) CT scan showing subdural hemorrhage at the right cranial convexity with a midline shift to the left, and effacement of the right lateral ventricle and basal cistern. (C) Protruded swollen brain after decompressive craniectomy. (D, E) Smartphone photographs of the fundus, showing numerous multilayered retinal hemorrhages and a portion of a white retinal ridge (asterisk) with a cherry hemorrhage (white arrow) in the right eye (D) and the left eye (E). (F) Hemorrhages inside the dural sheath of the optic nerve (arrowheads) and cherry retinal hemorrhages (red arrows) in both eyes.

Reference

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