Unusual manifestations of child abuse

Cases of child abuse are seen each day in the clinics, emergency departments, private offices, and public and private hospitals. Unusual presentations are intermixed with the straightforward, conventional, and well-understood cases. Fatal pepper aspiration, abdominal injuries ranging from rents in the liver and spleen, transection of the pancreas, and traumatic pseudocysts of that organ are described here. The triad of signs dubbed the "tin ear syndrome" consists of bruising of the ear, retinal hemorrhages, and cerebral edema. Toxic ingestions, mainly of cocaine, and its related paraphernalia are described in addition to peculiar tissue-specific microwave oven burns, an inflicted injury that rational minds find hard to comprehend. Finally, the bizarre syndrome of Münchausen by proxy is reviewed, and some understanding of the dynamics of this disorder has begun. Knowledge about these diagnostic oddities will enable us to intervene and attempt to alter the outcome in these dysfunctional families. The authors would welcome other case reports of unusual manifestations of child abuse, neglect, and child sexual abuse.