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Virtual Pediatric Hospital: Thoracopaedia: An Imaging Encyclopedia of Pediatric Thoracic Disease: Case 65 Thoracopaedia: An Imaging Encyclopedia of Pediatric Thoracic Disease

Case 65

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed

Chief Complaint:
Seventeen month old female status post fall

Clinical History:
The patient was a 17 month old female who fell down 12 steps in her grandmother's arms with the grandmother landing on the child's head and smothering her.

Clinical Physical Exam:
The patient had abnormal posturing and a blown left pupil.

Clinical Labs:

Clinical Differential Diagnosis:
Diffuse cerebral edema

Imaging Findings:
Chest film showed air in the mediastinum. Head CT exam showed diffuse cerebral edema and left contusion, subarachnoid hemorrhage, a frontal skull fracture, and air dissecting in the neck. An abdomen CT exam showed air in the mediastinum and a small right pneumothorax.

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Imaging Differential Diagnosis:

Operative Findings:

Pathological Findings:

Final Diagnosis:

Follow-up and Prognosis:
The patient was felt to be brain dead and had a nuclear medicine brain scan which confirmed the diagnosis. She was taken off of life support and died.

Similar Cases:


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