Periadventitial extracranial vertebral artery hemorrhage in a case of shaken baby syndrome.

We report a case of a two-month-old boy who became unresponsive in the sole custody of his father. Resuscitation efforts on route to the hospital were able to restore the infant's heart beat. However, neurologic function never recovered. Autopsy revealed massive cerebral edema, recent subdural, and subarachnoid hemorrhages, bilateral retinal hemorrhages, and cervical spine ligament hemorrhages. Separation of individual cervical vertebrae showed extensive, bilateral, periadventitial vertebral artery hemorrhages between C1 and C4, with corresponding luminal compression of the vertebral arteries. The importance of this previously unreported phenomena of periadventitial vertebral artery hemorrhage in the setting of shaken baby syndrome is discussed.

Streptococcal toxic shock syndrome presenting as suspected child abuse.

Natural disease processes can predispose individuals to develop external body lesions that mimic traumatic injury. This can be particularly problematic in pediatric cases in which clinicians are alerted to the problems of child abuse. Streptococcal toxic shock syndrome is a systemic infectious illness that can manifest itself with erythematous and necrotizing skin lesions. We report a fatal case of streptococcal toxic shock syndrome in a 4-year-old girl who presented with skin lesions that were initially thought to be traumatic in origin. A report of possible child abuse was filed with the state. Based on the morphologic findings and bacteriologic culture results at autopsy, these lesions and the cause of death in this case were instead determined to result from streptococcal toxic shock syndrome.

Rib fractures in 31 abused infants: postmortem radiologic-histopathologic study.

PURPOSE: To examine the morphologic alterations of fractures of the lateral and anterior rib arcs and costochondral junction (CCJ) to better understand the factors that influence radiographic visualization and to gain insight into the mechanism of injury in rib fractures of abused infants. MATERIALS AND METHODS: Thirty-one infants (average age, 3 months) who died with inflicted skeletal injuries were studied with high-detail, pre- or postmortem skeletal surveys, or both, and radiography of specimens, with histologic analysis. The distribution and number of fractures were determined for each technique, and dating was performed on the basis of radiographic and histologic criteria. The radiologic features were correlated with the pathologic findings in comparable histologic sections. RESULTS: Of 165 fractures, 84 (51%) involved the ribs. Only 30 rib fractures (36%) were visible with skeletal survey examination. Lateral and anterior arc fractures tended to impact along the inner cortex of the rib. CCJ fractures tended to involve the inner aspect of the osteochondral interface with an associated osseous fragment. CONCLUSION: Acute and healing rib fractures are common in infants who died with inflicted injury; detection is technique-dependent. Use of high-detail skeletal radiography to identify these injuries in live and deceased infants appears justified.