title: Fatal child abuse presenting with multiple vertebral and vascular trauma.
abstract: This case study involves the unexplained death of a previously healthy 30-month-old child. Reportedly, she was found unresponsive by her foster father following a 2-hour nap. She was transported to the hospital and died in the emergency room of unknown causes. Blood drawn in the ER showed hemoglobin of 4.3 mg/dL. Postmortem skeletal survey, magnetic resonance imaging (MRI) of the brain, and retinal examinations were negative. The medical examiner assumed jurisdiction of the body. The autopsy showed massive retroperitoneal hemorrhage, transections of the abdominal aorta, and inferior vena cava, and complete tears of the anterior longitudinal ligament of the spine at C5/C6 and L1/L2 with diastases of the vertebral bodies at the corresponding intervertebral disk spaces. The case is believed to be extraordinary due to both the extent of injury that does not match the reported history and the mechanism of vertebral and vascular injuries.
authors.affiliation: Office of the Jackson County Medical Examiner, 660 E 24th St., Kansas City, MO; School of Medicine, University of Missouri Kansas City, 2411 Holmes St., Kansas City, MO.
authors.forename: Mary H
authors.initials: MH
authors.lastname: Dudley
authors.forename: Megha
authors.initials: M
authors.lastname: Garg
mesh_terms: D001012:Aorta, Abdominal / Q000293:injuries* / Q000473:pathology; D002574:Cervical Vertebrae / Q000293:injuries* / Q000473:pathology; D002649:Child Abuse / Q000175:diagnosis*; D002675:Child, Preschool; D005260:Female; D049429:Forensic Pathology; D006470:Hemorrhage / Q000473:pathology; D006708:Homicide; D006801:Humans; D017846:Longitudinal Ligaments / Q000293:injuries* / Q000473:pathology; D008159:Lumbar Vertebrae / Q000293:injuries* / Q000473:pathology; D012187:Retroperitoneal Space / Q000473:pathology; D016103:Spinal Fractures / Q000473:pathology; D014682:Vena Cava, Inferior / Q000293:injuries* / Q000473:pathology
keywords: child abuse; forensic pathology; forensic science; single episode fatality; vascular injury; vertebral fracture