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Commotio cordis: A case report of a fatal blow
Dena Nazer1, Nirupama Kannikeswaran2, Carl Schmidt3
1Kids TALK Children's Advocacy Center, Children's Hospital of Michigan, Wayne State University, Detroit, Michigan, USA.
Insights
Commotio cordis, or sudden death from a chest blow, can occur in infants due to non-accidental trauma. Autopsy and imaging revealed child abuse, not heart abnormalities, as the cause of death.
Area of Science:
- Pediatric Pathology
- Forensic Pathology
- Cardiology
Background:
- Commotio cordis, caused by blunt chest trauma, can lead to fatal ventricular fibrillation in children.
- While often linked to sports injuries in adolescents, it can also result from non-accidental trauma in infants.
Observation:
- A 6-month-old infant presented in cardiac arrest with no external signs of trauma.
- Postmortem imaging identified fractures specific to physical abuse (healing rib and metaphyseal corner fractures).
- Autopsy revealed a structurally normal heart without microscopic abnormalities.
Findings:
- The infant's father confessed to striking the child's chest, leading to unresponsiveness.
- The cause of death was determined to be homicide secondary to commotio cordis.
- Diagnosis relies on mechanism of injury and imaging, as cardiac autopsy findings are typically normal.
Implications:
- Early identification of non-accidental trauma is critical for preventing further child abuse.
- Thorough on-scene and injury mechanism investigations are vital for diagnosing commotio cordis in infants.
- This case highlights the importance of considering abuse in unexplained pediatric sudden death.
Abstract:
Commotio cordis secondary to a blunt blow to the chest wall can result in ventricular fibrillation and sudden death in children. While it is commonly reported in adolescents during sporting activities, it may result from non-accidental trauma especially in infants and younger children. We report a case of a 6-month-old baby boy who presented to the emergency department in cardiac arrest. The patient's hospital records, postmortem imaging, and the autopsy results were reviewed. External examination of the infant did not reveal any evidence of trauma. Postmortem imaging revealed multiple healing posterior rib fractures and a metaphyseal corner fracture, both considered fractures highly specific for physical abuse. The autopsy revealed a structurally normal heart with no microscopic abnormalities. The infant's father confessed to hitting the child on the chest after which the child became unresponsive. Given the constellation of postmortem imaging and autopsy findings in addition to the father's confession, the child's death was ruled as a homicide secondary to commotio cordis. Since there are no structural and microscopic abnormalities in the heart autopsy in cases of commotio cordis, timely on-scene investigation and a thorough investigation regarding the mechanism of injury are required to make this diagnosis. Early identification of non-accidental trauma is crucial and can prevent further abuse in other siblings.
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