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Published on: March 12, 2020
Chylothorax and child abuse
1Divisions of Critical Care and Child Abuse Pediatrics, Department of Pediatrics, University of Texas Health Science Center San Antonio, San Antonio, TX, USA. anderst@uthscsa.edu
Insights
Chylothorax in infants can be a subtle sign of child abuse, not just illness. Thorough investigation is crucial when abuse is suspected, even with unusual presentations.
Area of Science:
- Pediatric Critical Care Medicine
- Child Abuse Recognition
- Diagnostic Challenges in Pediatrics
Background:
- Chylothorax in young children can stem from systemic illness, be idiopathic, or indicate child abuse.
- Unusual presentations of child abuse pose diagnostic challenges in critical care settings.
Observation:
- A case report details an unusual presentation of child abuse in a 6-month-old infant within a pediatric intensive care unit.
- The infant's condition, chylothorax, was initially considered potentially idiopathic or due to systemic illness.
Findings:
- Child abuse may manifest with subtle or atypical findings, delaying diagnosis.
- In this case, the diagnosis of abusive injury was not immediately apparent to the clinicians.
Implications:
- Clinicians should consider child abuse in the differential diagnosis of chylothorax in young children.
- A comprehensive evaluation, including skeletal surveys and specialist consultations, is vital when child abuse is suspected.
- Re-evaluation of radiographic studies and patient examination is recommended before diagnosing idiopathic chylothorax.
Objective:
Report of an unusual presentation of child abuse in a critical care setting.
Design:
Case report.
Setting:
Pediatric intensive care unit of a tertiary care hospital.
Patient:
A 6-month-old infant.
Background:
Chylothorax in young children can be a sign of systemic illness or a nondisease entity (idiopathic); however, it also can be the only apparent manifestation of child abuse.
Clinical Relevance:
Child abuse can present with unusual findings, and the diagnosis is not always apparent. In this and previous case reports of child abuse presenting as chylothorax, the diagnosis of abusive injury was not initially made by the managing clinicians. When abusive injury is in the differential diagnosis of a child's condition, a thorough and complete investigation-including skeletal survey, eye exam by an ophthalmologist, cranial neuroimaging, and consultation with child abuse physicians and child protective services-may be indicated.
Conclusion:
Before diagnosis of idiopathic chylothorax is made in a young child, clinicians should reexamine the patient and all radiographic studies, searching for findings that may indicate abuse. Further evaluation with a dedicated skeletal survey is suggested.
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