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Auen T, Linde E. An Autopsy Case of Abdominal Aortic Aneurysm in a Pediatric Decedent With Tuberous Sclerosis Complex. Am J Forensic Med Pathol 2024; 45:72-76. [PMID: 37486961 DOI: 10.1097/paf.0000000000000860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
ABSTRACT Vascular involvement in tuberous sclerosis complex (TSC) is uncommon and even more so in pediatric patients. When asymptomatic, these vascular abnormalities carry increased risk of rupture with increased morbidity and mortality. Here, we describe a case of a ruptured unrecognized abdominal aortic aneurysm in an 11-month-old patient with a history of TSC. The abdominal aortic aneurysm was discovered at autopsy and highlights the rarity of abdominal aortic aneurysm in pediatric patients diagnosed with TSC and the importance of screening for associated aneurysmal disease in the pediatric population with TSC. Furthermore, the extensive retroperitoneal hemorrhage seen in this case also highlights a rare but potential mimic of abuse in the pediatric population.
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Affiliation(s)
- Thomas Auen
- From the Department of Pathology and Microbiology, Nebraska Medical Center, University of Nebraska Medical Center
| | - Erin Linde
- Physicians Laboratory Services, Omaha, NE
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2
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Webb M, Sherman SS, Sung L, Schmidt CJ, Hlavaty L. Abusive Pediatric Thoracolumbar Fracture Due to Forced Hyperextension: Case Report, Biomechanical Considerations, and Review of the Literature. J Forensic Sci 2020; 65:2023-2029. [PMID: 32804424 DOI: 10.1111/1556-4029.14521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/20/2020] [Accepted: 07/06/2020] [Indexed: 11/28/2022]
Abstract
Pediatric thoracolumbar fractures are rare due to the physiological differences which afford greater resilience to the immature spine. Most pediatric thoracolumbar fractures occur as the result of high energy trauma, such as motor vehicle accidents, and modes of reasonable accidental injuries are limited by age and developmental capabilities of the child. These fractures can occur as the result of inflicted blunt force trauma and child abuse, and in most cases, the mechanism of injury to the spine is not known. We report the death of a 29-month-old man due to blunt force trauma to the back and forced hyperextension of the thoracolumbar spine causing fracture of the fourth lumbar (L4) vertebral body. A complete forensic examination revealed a previous healing fracture of the anterior aspect of the L4 vertebral body, with acute disruption of the anterior longitudinal ligament overlying the fracture site, complete fracture of the vertebral body, and fatal retroperitoneal hemorrhage. We present a review of the biomechanical considerations of the pediatric spine, a survey of pediatric spinal fractures, and a review of the literature on pediatric abusive thoracolumbar fractures. In this case, there was never a provided explanation for how the injury occurred; however, understanding the biomechanics of the pediatric spine allowed for the determination of the mechanism, force required to produce this specific pattern of abusive spinal injury, and the manner of death.
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Affiliation(s)
- Milad Webb
- Wayne County Medical Examiner's Office, Michigan Medicine, 1300 Warren Avenue, Detroit, Michigan, 48207
| | | | - LokMan Sung
- Wayne County Medical Examiner's Office, Michigan Medicine, 1300 Warren Avenue, Detroit, Michigan, 48207
| | - Carl J Schmidt
- Wayne County Medical Examiner's Office, Michigan Medicine, 1300 Warren Avenue, Detroit, Michigan, 48207
| | - Leigh Hlavaty
- Wayne County Medical Examiner's Office, Michigan Medicine, 1300 Warren Avenue, Detroit, Michigan, 48207
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3
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Inferior mesenteric artery laceration associated with blunt abdominal trauma with Casper's sign in a physically abused child: An autopsy case and literature review. J Forensic Leg Med 2020; 74:102001. [PMID: 33012316 DOI: 10.1016/j.jflm.2020.102001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 11/21/2022]
Abstract
There have been few studies of the death of children secondary to child abuse-related abdominal compression, and the detailed pathophysiology of such deaths is therefore unknown. The autopsy findings of a 3-year-old boy who died of hemorrhagic shock due to non-accidental severe blunt abdominal trauma were compared to those of children who died of other non-accidental abdominal injuries. Old and acute subcutaneous hemorrhages, abrasions, and scars were present all over the subject's body. No superficial injuries were found on the ventral midline, but a minor hemorrhage was found in the subcutaneous fat tissue, as well as in the rectus abdominis muscle. The intraperitoneal space contained 450 mL of blood, including coagulated blood. There was a tear in the transverse mesocolon and a crush injury in the small bowel mesentery. The inferior mesenteric artery was transected 0.5 cm from the aortic root. The transverse colon was necrotic, with hemorrhages in the mucosa. Since various organs were ischemic, the cause of death was determined to be blood loss from the inferior mesenteric artery injuries. Blunt abdominal trauma in children usually causes organ damage and intestinal injury, but because it is caused on the posterior surface of the mesentery, vascular injury should also be considered, and an autopsy should be performed. In the case of child abuse-related deaths, damage to the skin surface may not always be present; therefore, imaging tests, histopathological examinations, and biochemical tests should be performed with a focus on the gross anatomy to determine the cause of death and pathology.
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Abstract
Sudden death of a child beyond infancy is a rare event. We report a child who presented to the emergency care system with asystole and the caregiver's report of an asthma attack as the preceding event. After unsuccessful attempts at resuscitation, an autopsy was performed by the medical examiner. Despite only scattered bruises with no clear-cut signs of abuse, aortic rupture and spinal fractures were found. This case highlights the crucial role of the medical examiner in evaluating sudden childhood death, even in the setting of underlying illness.
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Karaolanis G, Moris D, McCoy CC, Tsilimigras DI, Georgopoulos S, Bakoyiannis C. Contemporary Strategies in the Management of Civilian Abdominal Vascular Trauma. Front Surg 2018; 5:7. [PMID: 29516005 PMCID: PMC5826055 DOI: 10.3389/fsurg.2018.00007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 01/29/2018] [Indexed: 12/17/2022] Open
Abstract
The evaluation and management of patients with abdominal vascular trauma or injury requires immediate and effective decision-making in these unfavorable circumstances. The majority of these patients arrive at trauma centers in profound shock, secondary to massive blood loss, which is often unrelenting. Moreover, ischemia, compartment syndrome, thrombosis, and embolization may also be life threatening and require immediate intervention. To minimize the risk of these potentially lethal complications, early understanding of the disease process and emergent therapeutic intervention are necessary. In the literature, the management of acute traumatic vascular injuries is restricted to traditional open surgical techniques. However, in penetrating injuries surgeons often face a potentially contaminated field, which renders the placement of prosthetic grafts inappropriate. Currently, however, there are sparse data on the management of vascular trauma with endovascular techniques. The role of endovascular technique in penetrating abdominal vascular trauma, which is almost always associated with severe active bleeding, is limited. It is worth mentioning that hybrid operating rooms with angiographic radiology capabilities offer more opportunities for the management of this kind of injuries by either temporary control of the devastating bleeding using endovascular balloon tamponade or with embolization and stenting. On the other hand, blunt abdominal injuries are less dangerous and they could be treated at most times by endovascular means. Since surgeons continue to encounter abdominal vascular trauma, open and endovascular techniques will evolve constantly giving us encouraging messages for the near future.
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Affiliation(s)
- Georgios Karaolanis
- First Department of Surgery, Division of Vascular Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Moris
- Department of Surgery, Duke University Hospital, Durham, NC, United States
| | - C. Cameron McCoy
- Department of Surgery, Duke University Hospital, Durham, NC, United States
| | - Diamantis I. Tsilimigras
- First Department of Surgery, Division of Vascular Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotirios Georgopoulos
- First Department of Surgery, Division of Vascular Surgery, National and Kapodistrian University of Athens, Athens, Greece
| | - Chris Bakoyiannis
- First Department of Surgery, Division of Vascular Surgery, National and Kapodistrian University of Athens, Athens, Greece
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6
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Distraction Injury of the Thoracic Spine With Spinal Cord Transection and Vascular Injury in a 5-Week-Old Infant Boy: A Case of Child Physical Abuse. Pediatr Emerg Care 2017. [PMID: 26196364 DOI: 10.1097/pec.0000000000000471] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Distraction injury of the spine with spinal cord transection and adjacent vascular injury is rarely described in the setting of child physical abuse. We report a 5-week-old infant boy who sustained these injuries after an abusive event. The clinical presentation, imaging findings, and recommended evaluation modalities are discussed. An overview of pediatric spinal column and vascular injuries secondary to physical abuse is given.
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Goodpasture ML, Zeller KA, Petty JK. Pediatric child abuse victim with posttraumatic inferior vena cava thrombosis. Pediatr Surg Int 2014; 30:569-71. [PMID: 24578163 DOI: 10.1007/s00383-014-3487-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/17/2014] [Indexed: 11/25/2022]
Abstract
Posttraumatic inferior vena cava thrombosis (IVCT) is very rare, with only a few cases reported in the literature. While thromboembolism as a result of trauma is common in adult patients, it is very rare in young children and seldom involves the inferior vena cava. We report the youngest patient to date with IVCT and the only child reported whose findings are the result of child physical abuse. The diagnosis can be challenging both clinically and radiographically. Additionally, the risks of morbidity and even mortality associated with an IVCT if untreated are significant.
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Affiliation(s)
- Meggan L Goodpasture
- Department of Pediatrics, Wake Forest Baptist Medical Center, 1 Medical Center Boulevard, Winston-Salem, NC, 27157, USA,
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Jesus-Silva SGD, Cardoso RS, Silva MADM, Maringolo LGF, Rodrigues MM, Miranda Jr. F. A case study involving a blunt abdominal trauma leading to disruption of the aortic bifurcation in an infant. J Vasc Bras 2014. [DOI: 10.1590/jvb.2014.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The incidence of aortic disruption secondary to blunt abdominal trauma is rarely reported in the pediatric population. In general, most of the cases described are the result of motor vehicle accidents. We report on the treatment and outcomes of a 5-year-old child with aortic bifurcation disruption secondary to an unusual case of blunt abdominal trauma who was admitted to the emergency room in hypovolemic shock and subjected to immediate exploratory laparotomy and vascular repair. The mechanical forces involved in aortic disruption and the management options for repair and treatment of this injury will be discussed.
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9
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Dudley MH, Garg M. Fatal Child Abuse Presenting with Multiple Vertebral and Vascular Trauma. J Forensic Sci 2014; 59:386-9. [DOI: 10.1111/1556-4029.12326] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Revised: 12/26/2012] [Accepted: 12/29/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Mary H. Dudley
- Office of the Jackson County Medical Examiner; 660 E 24th St. Kansas City MO
- School of Medicine; University of Missouri Kansas City; 2411 Holmes St. Kansas City MO
| | - Megha Garg
- Office of the Jackson County Medical Examiner; 660 E 24th St. Kansas City MO
- Saint Louis University; 221 North Grand Boulevard Saint Louis MO
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10
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Sadaghianloo N, Jean-Baptiste E, Breaud J, Declemy S, Kurzenne JY, Hassen-Khodja R. Blunt abdominal aortic trauma in paediatric patients. Injury 2014; 45:183-91. [PMID: 23174319 DOI: 10.1016/j.injury.2012.10.033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 10/06/2012] [Accepted: 10/27/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND Blunt abdominal aortic trauma (BAAT) is a very rare occurrence in children, with significant morbidity and mortality. Varied clinical presentations and sparse literature evidence make it difficult to define the proper management policy for paediatric patients. METHOD We report our centre's data on three consecutive children with BAAT managed between 2006 and 2010. A Medline search was also performed for relevant publications since 1966, together with a review of references in retrieved publications. RESULTS Forty children (range 1-16 years) were included in our final analysis. Motor vehicle crashes (MVC) were the leading cause of injury (65%). The in-hospital mortality rate was 7.5% (3/40). Nine patients (22.5%) ended up with residual sequelae. Main primary aortic lesions were complete wall rupture (12.5%), intimal transection (70%) and pseudoaneurysm (15%). Twenty-eight children underwent aortic surgical repair (70%). Among the 12 non-operatively managed patients, 41.6% had complications, including one death. CONCLUSION Symptomatic lesions and complete ruptures should undergo immediate surgical repair. Circumferential intimal transections are at high risk of complication and should also receive intervention. Partial intimal transections and delayed pseudoaneurysms can be initially observed by clinical examination and imaging. Patients with these latter pathologies should be operated on at any sign of deterioration.
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Affiliation(s)
- Nirvana Sadaghianloo
- Université de Nice Sophia Antipolis, France; Service de chirurgie vasculaire, Pôle cardio-vasculaire, thoracique et métabolique du Haut Pasteur, CHU de Nice, France
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11
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Blunt abdominal aortic injury. J Vasc Surg 2012; 55:1277-85. [DOI: 10.1016/j.jvs.2011.10.132] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2011] [Revised: 09/15/2011] [Accepted: 10/13/2011] [Indexed: 11/19/2022]
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West CA, Johnson LW, Doucet L, Shah M, Khan I, Heldmann M. Acute aortic occlusion in a child secondary to lap-belt injury treated with thromboendarterectomy and primary repair. J Vasc Surg 2011; 54:515-8. [DOI: 10.1016/j.jvs.2010.12.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Revised: 12/06/2010] [Accepted: 12/06/2010] [Indexed: 10/18/2022]
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Hornez E, Bourgouin S, Baudoin Y, Prunet B, Monchal T, Schlienger G, Meyrat L, Thouard H. [Management of seat-belt aorta in severe polytrauma: a review]. JOURNAL DES MALADIES VASCULAIRES 2011; 36:237-242. [PMID: 21684701 DOI: 10.1016/j.jmv.2011.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Accepted: 05/05/2011] [Indexed: 05/30/2023]
Abstract
Blunt trauma of the abdominal aorta is rare. Secondary to high-energy trauma, it is observed mainly in association with complex lesions. Evaluation of injury to the aorta must be a priority due to the risk of life-threatening massive hemorrhage. The clinical presentation can be quite obvious but also variable and often misleading. If in doubt, a systematic injected whole body scan is essential to diagnose aortic lesions. Hemorrhage or ischemia dictates emergency laparotomy. Opening the retroperitoneum increases the risk of infection if there is an associated gastrointestinal tract injury and may contraindicate use of arterial prostheses. Endovascular treatment can be proposed for less symptomatic lesions, including intimal dissection. Stents can be inserted via a femoral approach. In the event of juxtarenal dissection, there is a risk of renal artery thrombosis. Endovascular treatment is currently not recommended. This treatment can be delayed for a few days if necessary. Morbidity is low and long-term results are good.
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Affiliation(s)
- E Hornez
- Service de chirurgie digestive et vasculaire, département d'anesthésie réanimation, hôpital d'Instruction des Armées, boulevard Sainte-Anne, Toulon, France.
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Blanco FC, Powell DM, Guzzetta PC, Burd RS. Aortic bifurcation rupture after blunt abdominal trauma in a child: a case report. J Pediatr Surg 2011; 46:1452-4. [PMID: 21763853 DOI: 10.1016/j.jpedsurg.2011.03.072] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2011] [Revised: 03/27/2011] [Accepted: 03/28/2011] [Indexed: 11/26/2022]
Abstract
Blunt trauma to the abdomen resulting in aortic injury is rare in children with only a few case reports in the past 40 years. We describe the diagnosis and management of a 2-year-old boy who survived an aortic bifurcation rupture after blunt trauma.
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Affiliation(s)
- Felix C Blanco
- Division of Pediatric Surgery, Joseph E. Robert Center for Surgical Care, Children's National Medical Center, Washington, DC, USA
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15
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Lieberman I, Chiasson D, Podichetty VK. Aortic disruption associated with L2-L3 fracture-dislocation in a case of child abuse: a case report. J Bone Joint Surg Am 2010; 92:1670-4. [PMID: 20595576 DOI: 10.2106/jbjs.i.01404] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Isador Lieberman
- Texas Back Institute, 6020 West Parker Road, Plano, TX 75093, USA.
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16
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Kobayashi T, Matsuda K, Iwase F, Miyazaki Y, Amenomori S, Kikuchi H, Nakajima M. Blunt abdominal aortic injury in a child: a case report. ACTA ACUST UNITED AC 2010. [DOI: 10.3893/jjaam.21.343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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17
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Traumatic abdominal aortic dissection in a 16-month-old child. Pediatr Radiol 2009; 39:750-3. [PMID: 19340420 DOI: 10.1007/s00247-009-1224-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2009] [Revised: 02/13/2009] [Accepted: 03/02/2009] [Indexed: 10/20/2022]
Abstract
Abdominal aortic injury after blunt trauma is rare in the pediatric population. There have been fewer than 20 reported cases in the literature since 1960, and most were the result of motor vehicle collisions. We report the case of a 16-month-old boy who is the youngest reported patient to sustain this type of injury. We discuss the radiologic findings in multiple imaging modalities, mechanisms, associated injuries and management options.
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Endovascular Management of Stenosis of the Infrarenal Aorta Secondary to Blunt Abdominal Aortic Trauma in a Multiply Injured Patient. ACTA ACUST UNITED AC 2009; 66:E81-5. [DOI: 10.1097/01.ta.0000238651.56585.e4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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McCarthy MC, Price SW, Rundell WK, Lehner JT, Barney LM, Ekeh AP, Saxe JM, Woods RJ, Walusimbi MS. Pediatric blunt abdominal aortic injuries: case report and review of the literature. ACTA ACUST UNITED AC 2008; 63:1383-7. [PMID: 17308495 DOI: 10.1097/01.ta.0000224912.06226.2c] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Mary C McCarthy
- Department of Surgery, Wright State University, Dayton, Ohio, USA.
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22
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Abstract
A 66-year-old, restrained driver involved in a high-speed motor vehicle crash sustained a transmural infrarenal fracture of a circumferentially calcified aorta. Blunt abdominal aortic injury is exceedingly rare, about twenty times less common than its thoracic counterpart, and the current case report is therefore unusual. A high index of suspicion in combination with a suggestive clinical history or examination should prompt diagnostic intervention, as both morbidity and mortality are high.
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Inaba K, Kirkpatrick AW, Finkelstein J, Murphy J, Brenneman FD, Boulanger BR, Girotti M. Blunt abdominal aortic trauma in association with thoracolumbar spine fractures. Injury 2001; 32:201-7. [PMID: 11240295 DOI: 10.1016/s0020-1383(00)00203-5] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
All patients with blunt abdominal aortic disruption (BAAD) in the trauma registries at the three Regional Trauma Centres were retrospectively reviewed over the last decade. From the 11465 trauma admissions ISS>16,194 sustained aortic injuries. Eight cases of BAAD were identified, six with concurrent thoracolumbar spine (TLS) fractures (mean ISS 42). Patients with BAAD and TLS were subject to a detailed analysis. Clinically, three injury types were seen, hemodynamically unstable (uncontained full thickness laceration), stable symptomatic (intimal dissection with occlusion), and stable asymptomatic (contained full thickness laceration or intimal dissection without occlusion). All spinal column fractures involved a distractive mechanism, one with both distractive and translational fracture components. We propose that a distractive force, applied to the aorta lying anterior to the anterior longitudinal ligament, results in an aortic injury spectrum ranging from an intimal tear to a full thickness laceration, as a related injury. Computed tomography (CT) was an important imaging modality in the stable asymptomatic patients. All intimal dissections without occlusion were managed non-operatively. With distractive TLS fractures, BAAD needs to be considered.
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Affiliation(s)
- K Inaba
- London Health Sciences Centre, Ont., London, Canada
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25
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Martínez S, Lozano P, artigues I, Plaza A, Juliá J, Tadeo Gómez F. Trombosis aórtica por cinturón de seguridad. ANGIOLOGIA 2000. [DOI: 10.1016/s0003-3170(00)76126-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Child abuse has been documented in various forms since the beginning of recorded history. This article reviews the legal aspects of reporting child abuse, the epidemiology of child abuse, various physical manifestations of child abuse, and effective treatment procedures. It is only with the appropriate interventions that physicians can begin to make an impact on the future of abused children.
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Affiliation(s)
- A M Jain
- Department of Emergency Medicine, George Washington University, Washington, DC, USA
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