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Intra-Thoracic Injuries

The following is a summary of the systematic review findings up to the date of our most recent literature search. If you have a specific clinical case, we strongly recommend you read all of the relevant references as cited and look for additional material published outside our search dates.

 

 

One comparative study 4 of intra-thoracic injuries in children with rib fractures aged less than three years highlighted that: ·       

  •  abused children were more likely to be aged less than six months, whereas the majority of the accidentally injured children were aged one to three ·        
  • there was a correlation between the number of rib fractures and the extent of intra-thoracic injuries in the accidentally injured children but not the abused children

 

Cardiac and Vascular Injuries

  • Direct cardiac trauma were described in children aged nine weeks to five years 1-3,5,6
    • Half of the children died as a consequence of their injury 1-3
    • Injuries included traumatic ventriculoseptal defects 1,5,6, laceration and intimal tears of the right atrium 2,3, transmural laceration of the apex of the left ventricle 1 and traumatic right ventricular aneurysm 6
    • Co-existent injuries included abdominal injuries, fractures, and head injury

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References

  1. Cohle SD, Hawley DA, Berg KK, Kiesel E., Pless JE. Homicidal cardiac lacerations in children. Journal of Forensic Sciences. 1995;40(2):212-218 [Pubmed]
  2. Cumberland GD, Riddick L, McConnell CF. Intimal tears of the right atrium of the heart due to blunt force injuries to the abdomen: Its mechanism and implications. The American Journal of Forensic Medicine and Pathology. 1991;12(2):102-104 [Pubmed]
  3. deRoux SJ, Prendergast NC. Adrenal lacerations in child abuse: a marker of severe trauma. Pediatric Surgery International. 2000;16(1-2):121-123 [Pubmed]
  4. Darling SE, Done SL, Friedman SD, Feldman KW. Frequency of intrathoracic injuries in children younger than 3 years with rib fractures. Pediatric Radiology. 2014;44(10):1230-1236 [Pubmed]

  5. Karpas A, Yen K, Sell L., Frommelt PC. Severe blunt cardiac injury in an infant: A case of child abuse. The Journal of Trauma, Injury, Infection and Critical Care. 2002;52(4):759-764 [Pubmed citation only]
  6. Rees A, Symons J, Joseph M, Lincoln C. Ventricular septal defect in a battered child. British Medical Journal. 1975;1(5948):20-21 [Pubmed citation only]

  •  A single case described intra-cardiac needle insertion by the parent 1

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References

  1. Sola JE, Cateriano, JH, Thompson, WR, Neville, HL. Pediatric penetrating cardiac injury from abuse: a case report. Pediatric Surgery International. 2008;24(4):495-497 [Pubmed]

  • Vascular injuries included two injuries to the abdominal aorta 1,2
    • One occurred as a consequence of a kick to the abdomen, resulting in a large pseudo-aneurysm presenting four months after the assault 2
    • The second case was a fatal acute traumatic transection of the abdominal aorta in association with complete fracture-dislocation of the lumbar spine. This case was thought to be due to a hyperextension injury to the spine 1

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References

  1. Lieberman I, Chiasson D, Podichetty VK. Aortic disruption associated with L2-L3 fracture-dislocation in a case of child abuse: a case report. The Journal of Bone and Joint Surgery. 2010;92(7):1670-1674 [Pubmed citation only]
  2. Roche KJ, Genieser NB, Berger DK, Ambrosino MM. Traumatic abdominal pseudoaneurysm secondary to child abuse. Pediatric Radiology. 1995;25(Suppl 1):S247-248 [Pubmed]

 Pulmonary Trauma

  • Children aged three weeks to 18 months have been described with pulmonary contusions or subpleural contusions 1-5
    • Co-existent injuries included multiple rib fractures, head injury, bruising and abdominal injuries 1-5
    • The children presented with respiratory difficulty or collapse and pneumothorax in one case 1
  • In a comparative study of abused and non abused children less than three years with rib fractures and intra-thoracic injuries,
    • pneumathoraces, pulmonary contusion and pulmonary laceration were more common in abused than nonabused children
    • pleural effusion occurred equally in both groups (Darling)
    • there was no difference between groups in relation to co-existent intra-cranial or intra-abdominal injury

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References

  1. Dobi-Babic R, Katalinic S. Infanticide - Consequence of long-term alcoholism. Alcoholism. 2008;44(1):43-48
  2. Fain DB, McCormick GM. An unusual case of child abuse homicide/suicide. Journal of Forensic Sciences. 1988;33(2):554-557 [Pubmed]
  3. Gipson CL, Tobias JD. Flail chest in a neonate resulting from nonaccidental trauma. Southern Medical Journal. 2006;99(5):536-538 [Pubmed]
  4. McEniery J, Hanson R, Grigor, W, Horowitz A. Lung injury resulting from a nonaccidental crush injury to the chest. Pediatric Emergency Care. 1991;7(3):166-168 [Pubmed]
  5. Salmon MA. The spectrum of abuse in the battered-child syndrome. Injury. 1971;2(3):211-217 [Pubmed citation only]


  • One case recorded needle insertion into the neck, mediastinum, and left forearm. The mediastinal needle lay close to the great vessels 1

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References

  1. Ng CS, Hall CM, Shaw DG. The range of visceral manifestations of non-accidental injury. Archives of Disease in Childhood. 1997;77(2):167-174 [Pubmed citation only]

Pharyngeal and Oesophageal Trauma

(Pharyngeal injuries are also addressed in our Oral Injuries review)

  • Pharyngeal and oesophageal trauma were predominantly addressed in 10 studies 1-10
    • Injuries to the posterioir pharynx  included tear, and occasionally complication by retropharyngeal pouch or abscess formation 2-4,6-8,10
    • The children presented with subcutaneous emphysema, oral bleeding or drooling, respiratory distress or difficulty swallowing 2-4,6-8,10
  • Injuries to the oesophagus included laceration and perforation 1,5,9
    • These children were aged 0-9 months and all presented with irritability, poor feeding, respiratory distress or increasing swelling of the neck and chest with subcutaneous emphysema 1,5,9

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References

  1. Ablin DS, Reinhart MA. Esophageal perforation with mediastinal abscess in child abuse. Pediatric Radiology. 1990;20(7):524-525 [Pubmed]
  2. Bansal BC, Abramo TJ. Subcutaneous emphysema as an uncommon presentation of child abuse. American Journal of Emergency Medicine. 1997;15(6):573-575 [Pubmed]
  3. Grace A, Kalinkiewicz M, Drake-Lee AB. Covert manifestations of child abuse. British Medical Journal. 1984;289:1041-1042 [Pubmed citation only]
  4. Kleinman PK, Spevak MR, Hansen M. Mediastinal pseudocyst caused by pharyngeal perforation during child abuse. AJR American Journal of Roentgenology. 1992;158(5):1111-1113 [Pubmed citation only]
  5. Marupaka SK, Unnithan DV. Esophageal perforation in an abandoned newborn. Pediatrics International. 2007;49(3):400-402 [Pubmed citation only]
  6. McDowell HP, Fielding DW. Traumatic perforation of the hypopharynx - an unusual form of abuse. Archives of Disease in Childhood. 1984;59(9):888-889 [Pubmed]
  7. Ng CS, Hall CM, Shaw DG. The range of visceral manifestations of non-accidental injury. Archives of Disease in Childhood. 1997;77(2):167-174 [Pubmed citation only]
  8. Reece RM, Arnold J, Splain J. Pharyngeal perforation as a manifestation of child abuse. Child Maltreatment. 1996;1(4):364-367 [Abstract provided by Sage Journals]
  9. Tavill MA, Trimmer, WR, Austin, MB. Pediatric cervical esophageal perforation secondary to abusive blunt thoracic trauma. International Journal of Pediatric Otorhinolaryngology. 1996;35(3):263-269 [Pubmed]
  10. Tostevin PMJ, Hollis, LJ, Bailey, CM. Pharyngeal trauma in children - accidental and otherwise. The Journal of Laryngology and Otology. 1995;109(12):1168-1175 [Pubmed]

 Chylothorax

  •  Trauma to the thoracic duct leading to chylothorax is recorded in children aged 6-18 months 1-4
    • Children presented with increasing respiratory distress 1-4
    • All children had co-existent rib fractures, and other fractures 1-4
    • In addition bruising, subdural haematoma and corneal abrasions were noted in one case 1

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References

  1. Anderst JD. Chylothorax and child abuse. Pediatric Critical Care Medicine. 2007;8(4): 394-396 [Pubmed]
  2. Geismar SL, Tilelli JA, Campbell JB, Chiaro JJ. Chylothorax as a manifestation of child abuse. Pediatric Emergency Care. 1997;13(6):386-389 [Pubmed]
  3. Green HG. Child abuse presenting as chylothorax. Pediatrics. 1980;66(4):620-621 [Pubmed citation only]
  4. Guleserian KJ, Gilchrist BF, Luks FI, Wesselhoeft CW, DeLuca FG. Child abuse as a cause of traumatic chylothorax. Journal of Pediatric Surgery. 1996;31(12):1696-1697 [Pubmed]

 

 

 

 

 

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