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Yarid N, Brown EC, Boos M, Otjen J, Metz J, Jenny C, Feldman KW. Cardiac Ventricular Laceration Due to Child Abuse: Abusive Ventricular Laceration. J Forensic Sci 2018; 64:284-288. [PMID: 29989173 DOI: 10.1111/1556-4029.13857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 06/07/2018] [Accepted: 06/18/2018] [Indexed: 11/28/2022]
Abstract
Traumatic cardiac ventricular ruptures in children are rare. Only a single case of left ventricular rupture due to child abuse has been reported. We report a child who sustained a fatal left ventricular apical rupture. It appeared to have resulted from hydrostatic forces resulting from abusive blunt thoracic injury. That he was being abused was previously missed when he was presented to the emergency department with facial pyoderma. It was not noted that he also had lip and oral mucosal injury, sites not affected by staph toxins. As a result, his underlying, abusive and secondarily infected, facial flow type scald burn was not appreciated. Within a week thereafter his fatal injury occurred, accompanied by extensive and obvious associated abusive injuries. Postmortem high-detail whole body computed tomography scanning aided the autopsy. Although rare, ventricular rupture from abusive blunt thoracic injury can occur.
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Affiliation(s)
- Nicole Yarid
- The King County Medical Examiner's Office, Seattle, WA.,University of Washington School of Medicine, Seattle, WA
| | - Emily C Brown
- University of Washington School of Medicine, Seattle, WA.,Ambulatory Division of the Department of Pediatrics, Seattle Children's, Seattle, WA.,Children's Protection Program, Seattle Children's, Seattle, WA.,Seattle Children's, Seattle, WA
| | - Markus Boos
- University of Washington School of Medicine, Seattle, WA.,Seattle Children's, Seattle, WA.,Department of Dermatology, Seattle Children's, Seattle, WA
| | - Jeffrey Otjen
- University of Washington School of Medicine, Seattle, WA.,Seattle Children's, Seattle, WA.,Department of Radiology, Seattle Children's, Seattle, WA
| | - James Metz
- University of Washington School of Medicine, Seattle, WA.,Ambulatory Division of the Department of Pediatrics, Seattle Children's, Seattle, WA.,Children's Protection Program, Seattle Children's, Seattle, WA.,Seattle Children's, Seattle, WA
| | - Carole Jenny
- University of Washington School of Medicine, Seattle, WA.,Ambulatory Division of the Department of Pediatrics, Seattle Children's, Seattle, WA.,Children's Protection Program, Seattle Children's, Seattle, WA.,Seattle Children's, Seattle, WA
| | - Kenneth W Feldman
- University of Washington School of Medicine, Seattle, WA.,Ambulatory Division of the Department of Pediatrics, Seattle Children's, Seattle, WA.,Children's Protection Program, Seattle Children's, Seattle, WA.,Seattle Children's, Seattle, WA
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Maguire SA, Upadhyaya M, Evans A, Mann MK, Haroon MM, Tempest V, Lumb RC, Kemp AM. A systematic review of abusive visceral injuries in childhood--their range and recognition. CHILD ABUSE & NEGLECT 2013; 37:430-445. [PMID: 23306146 DOI: 10.1016/j.chiabu.2012.10.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2012] [Revised: 10/28/2012] [Accepted: 10/31/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To define what abusive visceral injuries occur, including their clinical features and the value of screening tests for abdominal injury among abused children. METHODS We searched 12 databases, with snowballing techniques, for the period 1950-2011, with all identified studies undergoing two independent reviews by trained reviewers, drawn from pediatrics, radiology, pediatric surgery and pathology. Of 5802 studies identified, 188 were reviewed. We included studies of children aged 0-18, with confirmed abusive etiology, whose injury was defined by computed tomography, contrast studies or at surgery/post mortem. We excluded injuries due to sexual abuse, or those exclusively addressing management or outcome. RESULTS Of 88 included studies (64 addressing abdominal injuries), only five were comparative. Every organ in the body has been injured, intra-thoracic injuries were commoner in those aged less than five years. Children with abusive abdominal injuries were younger (2.5-3.7 years vs. 7.6-10.3 years) than accidentally injured children. Duodenal injuries were commonly recorded in abused children, particularly involving the third or fourth part, and were not reported in accidentally injured children less than four years old. Liver and pancreatic injuries were frequently recorded, with potential pancreatic pseudocyst formation. Abdominal bruising was absent in up to 80% of those with abdominal injuries, and co-existent injuries included fractures, burns and head injury. Post mortem studies revealed that a number of the children had sustained previous, unrecognized, abdominal injuries. The mortality from abusive abdominal injuries was significantly higher than accidental injuries (53% vs. 21%). Only three studies addressed screening for abdominal injury among abused children, and were unsuitable for meta-analysis due to lack of standardized investigations, in particular those with 'negative' screening tests were not consistently investigated. CONCLUSIONS Visceral injuries may affect any organ of the body, predominantly abdominal viscera. A non-motor vehicle related duodenal trauma in a child aged<five years warrants consideration of abuse as an etiology. In the absence of clear evidence for a screening strategy, clinical vigilance is warranted in any young child with suspected abuse for the presence of abdominal injury, where the absence of abdominal bruising or specific symptoms does not preclude significant injury.
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Affiliation(s)
- S A Maguire
- Child Health Department, School of Medicine, Cardiff University, University Hospital of Wales, Heath Park, Cardiff CF14 4XN, UK
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Mason DT, Roberts WC. Isolated ventricular septal defect caused by nonpenetrating trauma to the chest. Proc (Bayl Univ Med Cent) 2006; 15:388-90. [PMID: 16333470 PMCID: PMC1276643 DOI: 10.1080/08998280.2002.11927871] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Dean T Mason
- Department of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland, USA
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Porzionato A, Montisci M, Basso C. Multiple heart and pericardial lacerations due to blunt trauma from assault. Cardiovasc Pathol 2004; 13:168-72. [PMID: 15081474 DOI: 10.1016/s1054-8807(04)00002-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2003] [Revised: 12/30/2003] [Accepted: 12/31/2003] [Indexed: 11/23/2022] Open
Abstract
A case of 80-year-old woman who died of hemorrhagic shock as a consequence of multiple heart and pericardial lacerations as well as myocardial contusion due to blunt trauma from assault is reported. At postmortem examination, fractures of the body of the sternum and bilateral ribs were detected. A laceration of the anterior left-sided pericardium, a 2.8-cm linear tear in the right venous sinus from the origin of the inferior to the origin of the superior vena cava, a 3-cm laceration between the venous sinus and the right auricle, and a 2-cm tear in the anterior wall of the left atrium, behind the aortic trunk, were visible. Multiple heart and pericardial lacerations were thought to be caused by compression of the heart between sternum and vertebrae, together with multiple rib fractures and extensive movements of the sternum toward the spine as a result of kicking.
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Affiliation(s)
- Andrea Porzionato
- Department of Environmental Medicine and Public Health, Section of Legal Medicine, University of Padova, Via Falloppio 50, 35121 Padua, Italy
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Harel Y, Szeinberg A, Scott WA, Frand M, Vered Z, Smolinski A, Barzilay Z. Ruptured interventricular septum after blunt chest trauma: ultrasonographic diagnosis. Pediatr Cardiol 1995; 16:127-30. [PMID: 7617506 DOI: 10.1007/bf00801910] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A 6-year-old child was found under a heavy bookcase that compressed her chest. On admission to the emergency room she was found to be dyspneic with a systolic murmur and complete atrioventricular (A-V) block. Her condition deteriorated rapidly, leading to cardiogenic shock and loss of consciousness. Echocardiographic Doppler evaluation demonstrated a large ventricular septal defect and tricuspid insufficiency. A pericardial patch was put over the tear in the septum, and torn chordae tendinae were reimplanted to the papillary muscles. A pacemaker was inserted. Her situation improved, but on the third day cardiogenic shock and right ventricular dysfunction ensued and the patient expired. A review of the previous 13 cases from the pediatric literature is presented.
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Affiliation(s)
- Y Harel
- Pediatric Critical Care Division, Chaim Sheba Medical Center, Tel Hashomer, Israel
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