title: Tufted angioma with Kasabach-Merritt syndrome mistaken for child abuse.
abstract: We report the case of a 2-month-old infant with a single apparently ecchymotic lesion on the shoulder that raised suspicions of abuse. The medicolegal examination concluded that the appearance of the lesion was only mildly suggestive of an ecchymosis. A second, temporally remote examination confirmed this doubt. The evolution of the lesion, notably an increase in its volume, allowed us to rule out a traumatic lesion and was suggestive of a vascular tumor. The histological type of the tumor was a tufted angioma. There was thrombocytopenia and consumptive coagulopathy. All these data confirmed the diagnosis of Kasabach-Merritt syndrome. In contrast to benign infantile hemangiomas, which are frequent and well-known in clinical practice, vascular tumors complicated by Kasabach-Merritt syndrome are rare. They deserve to be widely known because they mandate rapid medical management and because they are one of the only differential diagnoses of ecchymosis, especially in children. When there is doubt about the traumatic nature of a cutaneous lesion, a temporally remote examination is essential. The evolution of the lesion may then suggest a dermatologic origin.
authors.affiliation: Rennes University Hospital, Department of Forensic Medicine, 2 rue Henri Le Guilloux, 35033 Rennes Cedex 9, France; University of Rennes 1, Faculty of Medicine, 2, avenue du Professeur Léon Bernard, 35043 Rennes Cedex, France. Electronic address: renaud.bouvet@chu-rennes.fr.
authors.forename: Renaud
authors.initials: R
authors.lastname: Bouvet
authors.affiliation: Rennes University Hospital, Department of Forensic Medicine, 2 rue Henri Le Guilloux, 35033 Rennes Cedex 9, France.
authors.forename: Marion
authors.initials: M
authors.lastname: Pierre
authors.affiliation: Rennes University Hospital, Department of Pediatrics, 16 boulevard de Bulgarie, 35203 Rennes Cedex 2, France.
authors.forename: Fabienne
authors.initials: F
authors.lastname: Toutain
authors.affiliation: Rennes University Hospital, Department of Pediatrics, 16 boulevard de Bulgarie, 35203 Rennes Cedex 2, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Beucher
authors.affiliation: Rennes University Hospital, Department of Pediatrics, 16 boulevard de Bulgarie, 35203 Rennes Cedex 2, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Dabadie
authors.affiliation: University of Rennes 1, Faculty of Medicine, 2, avenue du Professeur Léon Bernard, 35043 Rennes Cedex, France; Rennes University Hospital, Department of Pathology, 2 rue Henri Le Guilloux, 35033 Rennes Cedex 9, France.
authors.forename: François
authors.initials: F
authors.lastname: Le Gall
authors.affiliation: Vitré Hospital, Department of Pediatrics, 30 route de Rennes, 35506 Vitré Cedex, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: François-Chervet
authors.affiliation: University of Rennes 1, Faculty of Medicine, 2, avenue du Professeur Léon Bernard, 35043 Rennes Cedex, France; Rennes University Hospital, Department of Pediatrics, 16 boulevard de Bulgarie, 35203 Rennes Cedex 2, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Pladys
authors.affiliation: Rennes University Hospital, Department of Pediatric Imaging, 16 boulevard de Bulgarie, 35203 Rennes Cedex 2, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Bruneau
authors.affiliation: Rennes University Hospital, Department of Forensic Medicine, 2 rue Henri Le Guilloux, 35033 Rennes Cedex 9, France; University of Rennes 1, Faculty of Medicine, 2, avenue du Professeur Léon Bernard, 35043 Rennes Cedex, France.
authors.forename: Mariannick
authors.initials: M
authors.lastname: Le Gueut
mesh_terms: D002649:Child Abuse / Q000175:diagnosis; D003937:Diagnosis, Differential; D004438:Ecchymosis / Q000209:etiology; D006391:Hemangioma / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D059885:Kasabach-Merritt Syndrome / Q000175:diagnosis*; D008297:Male; D012878:Skin Neoplasms / Q000175:diagnosis*
keywords: Child abuse; Differential diagnosis; Kasabach–Merritt syndrome; Tufted angioma