Chylothorax and child abuse.
OBJECTIVE
Report of an unusual presentation of child abuse in a critical care setting.


METHODS
Case report.


METHODS
Pediatric intensive care unit of a tertiary care hospital.


METHODS
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.


CONCLUSIONS
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.


CONCLUSIONS
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.
Anderst
James D
JD
Divisions 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
D002649:Child Abuse / Q000175:diagnosis*; D002916:Chylothorax / Q000209:etiology*; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D010808:Physical Examination