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Cardiac Ventricular Laceration Due to Child Abuse: Abusive Ventricular Laceration
Authors:Nicole Yarid M.D.  Emily C. Brown M.D.  Markus Boos M.D.   Ph.D.  Jeffrey Otjen M.D.  James Metz M.D.  Carole Jenny M.D.  Kenneth W. Feldman M.D.
Affiliation:1. The King County Medical Examiner's Office, Seattle, WA;2. University of Washington School of Medicine, Seattle, WA;3. Ambulatory Division of the Department of Pediatrics, Seattle Children's, Seattle, WA;4. Children's Protection Program, Seattle Children's, Seattle, WA;5. Seattle Children's, Seattle, WA;6. Department of Dermatology, Seattle Children's, Seattle, WA;7. Department of Radiology, Seattle Children's, Seattle, WA;8. Seattle Children's, Seattle, WACorresponding author: Kenneth Feldman, M.D, Seattle Children's, M/S M2‐10, 4800 Sand Point Way NE, PO 5371, Seattle, WA 98105. E‐mail:
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.
Keywords:forensic science  child abuse  cardiac trauma  cardiac ventricular lacerations  hemo‐pericardium  scald burn  autopsy  forensic pathology  postmortem CT
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