Chylothorax associated with child abuse
Yasuhiro Ichikawa1, Atsuo Sato1, Kodai Sato1
1Department of Pediatrics, Yokohama Rosai Hospital, Yokohama, Japan.
Pediatrics International : Official Journal of the Japan Pediatric Society
|September 22, 2015
Insights
A 10-month-old boy with respiratory distress was diagnosed with right chylothorax. Treatment included thoracic drainage and specialized nutrition, and old rib fractures suggested physical abuse.
Area of Science:
- Pediatrics
- Trauma Surgery
- Child Abuse Pediatrics
Background:
- Chylothorax, the accumulation of lymphatic fluid in the pleural space, can be idiopathic or secondary to various conditions.
- Infantile respiratory decompensation necessitates prompt diagnosis and management.
Observation:
- A 10-month-old male infant presented with acute respiratory distress.
- Imaging revealed right-sided chylothorax and bilateral old rib fractures on chest computed tomography.
- The infant's condition improved with thoracic drainage and nutritional therapy.
Findings:
- The clinical presentation and imaging findings raised suspicion for non-accidental trauma (physical abuse).
- Chylothorax in infants, particularly when associated with rib fractures, warrants a thorough investigation for child abuse.
- Successful management involved thoracic drainage and a specific nutritional regimen, including fasting and medium-chain triglyceride (MCT) milk.
Implications:
- This case highlights the importance of considering physical abuse in the differential diagnosis of chylothorax in infants.
- Early recognition and intervention are crucial for improving outcomes in pediatric patients with traumatic chylothorax.
- Healthcare providers should maintain a high index of suspicion for child abuse when encountering unexplained chylothorax with associated skeletal injuries in infants.
Abstract:
We report a case of right chylothorax associated with physical abuse in a 10-month-old boy who presented with respiratory decompensation. Chylothorax was improved by thoracic drainage and nutrition management, such as fasting followed by medium-chain triglyceride milk. Chest computed tomography on admission showed bilateral old rib fractures. Accordingly, physical abuse was suspected. Chylothorax of unknown cause in infancy, especially in those with coexisting rib fractures, must be scrutinized for child abuse.
Related Concept Videos
01:27Pneumothorax-II
1.4K
Pneumothorax is a medical condition defined by the buildup of air in the pleural space between the lungs and the chest wall. This accumulation of air can lead to partial or complete lung collapse, resulting in a range of clinical manifestations. Understanding the clinical presentation and effective management strategies is crucial for healthcare professionals in providing timely and appropriate care to individuals with pneumothorax.
Clinical Manifestations:
Clinical Manifestations:
1.4K
01:24Flail Chest-I
1.0K
Overview of Flail Chest
Flail chest is a severe and potentially life-threatening condition characterized by the fracture of three or more adjacent ribs in multiple places. It is most commonly caused by direct impacts and trauma, such as motor vehicle accidents or injuries from a steering wheel impact. It can also occur due to falls in elderly individuals with osteoporosis, or assaults involving sharp objects.
Pathophysiology
The pathophysiology of flail chest is complex, involving fractures of...
Flail chest is a severe and potentially life-threatening condition characterized by the fracture of three or more adjacent ribs in multiple places. It is most commonly caused by direct impacts and trauma, such as motor vehicle accidents or injuries from a steering wheel impact. It can also occur due to falls in elderly individuals with osteoporosis, or assaults involving sharp objects.
Pathophysiology
The pathophysiology of flail chest is complex, involving fractures of...
1.0K
01:26Pneumothorax-I
2.0K
A pneumothorax is a condition where air builds up in the space between the lung and the chest wall, causing the lung to collapse. This condition arises when air enters the space between the parietal and visceral pleura, disrupting the negative pressure essential for lung inflation. This can lead to a partial or complete collapse of the lung.
Pneumothorax can be even further classified as spontaneous, traumatic, and tension pneumothorax.
Pneumothorax can be even further classified as spontaneous, traumatic, and tension pneumothorax.
2.0K
01:26Endoscopic Studies II: Thoracocentesis
2.1K
Thoracentesis(Thoracocentesis), commonly known as pleural tap, is a medical procedure where a 22 gauge needle is inserted into the pleural space, the area between the lung and chest wall. This procedure is commonly performed to diagnose or treat various respiratory disorders.
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...
Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...
2.1K
01:26Flail Chest-II
885
Managing flail chest, a condition characterized by a segment of the chest wall moving independently from the rest of the thoracic cage, requires a comprehensive approach. It includes a thorough assessment of the patient's condition, a diagnostic evaluation to determine the extent of the injury, and the implementation of appropriate medical interventions tailored to the individual's needs.
Assessment:
1. Clinical Evaluation:
History:
Assessment:
1. Clinical Evaluation:
History:
885
01:17Pulmonary Cycle: Exhalation
4.9K
In terms of human respiration, the act of expelling air, known as exhalation (or expiration), operates on the principle of pressure gradients. During expiration, the pressure within the lungs exceeds that of the surrounding atmosphere. Under normal conditions, quiet breathing involves passive exhalation and is free of muscular contractions. This is because the exhalation process is driven by the natural elastic recoil of the lungs and chest wall, both of which have an inherent tendency to...
4.9K