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Abstract: Changes in society and developments within emergency care affect imaging in the emergency department. It is clear that radiologists have to be pro-active to even survive. High quality service is the goal, and if we are to add value to the diagnostic (and therapeutic) chain of healthcare, sub-specialization is the key, and, although specifically patient-oriented and not organ-based, emergency and trauma imaging is well suited for that. The development of emergency radiology in Europe and the United States is compared with emphasis on how different healthcare systems and medical cultures affect the utilization of Acute Care imaging. [Copyright &y& Elsevier]

Abstract: Hangman’s fractures are a rare finding in childhood. In case of suspected or proven child abuse, differentiation with a congenital defect of the posterior arch of C2 is essential. We present the case of a 5-month-old girl, who had a history of being physically abused by one of her caretakers. On the lateral view of the cervical spine, a defect of the posterior elements of C2 and an anterolisthesis of C2 on C3 was seen. CT scan showed a bilateral defect in the posterior elements of C2. No soft-tissue swelling of hematoma was noted. MRI showed a normal signal intensity of the intervertebral disc C2-C3. No haematoma was noted. Clinical examination revealed a slight head lag and local tenderness; there were no neurological deficits. This case shows that the differentiation between a congenital C2 arch defect and a hangman’s fracture is precarious. In this case the findings on MRI and CT scan were interpreted as a congenital posterior arch defect (spondylolysis). [Copyright &y& Elsevier]