{"id":1968,"date":"2024-10-21T11:49:35","date_gmt":"2024-10-21T15:49:35","guid":{"rendered":"https:\/\/wordpress.forensicpath.us\/?p=1968"},"modified":"2024-10-21T12:12:13","modified_gmt":"2024-10-21T16:12:13","slug":"pathology-cases-iatrogenic-subperiosteal-hemorrhage-mimicking-abusive-head-trauma","status":"publish","type":"post","link":"https:\/\/wordpress.forensicpath.us\/index.php\/2024\/10\/21\/pathology-cases-iatrogenic-subperiosteal-hemorrhage-mimicking-abusive-head-trauma\/","title":{"rendered":"Pathology cases — Iatrogenic subperiosteal hemorrhage mimicking abusive head trauma"},"content":{"rendered":"

This is a case that gave me a little pause.\u00a0 This not-quite-a-year-old infant was found dead at home.\u00a0 The story was one that I’ve seen a number of times — an odd combination of slightly suspicious circumstances and slightly suspicious external findings at the scene.\u00a0 In particular, there were anal lesions that some clinicians thought were suspicious of anal rape.\u00a0 They were mild anal erosions and a rash, and I won’t discuss them more here — if you are doing baby autopsies you *really* need to learn that infants of this age get anal erosions and can have rashes, and that’s not anal rape.But that’s for another time.<\/p>\n

In any case, when the child came in, I had a reasonably high level of suspicion of abuse.<\/p>\n

It was obvious that the folk in the ED made a heroic effort to save this child.\u00a0 There were a zillion needle puncture marks, including four or five intraosseous sticks.\u00a0 Upon reflection of the scalp, there was prominent subgaleal hemorrhage on the left, but it was associated with punctures of scalp veins and directly led to two prominent needle puncture marks of the scalp on that side:<\/p>\n

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However, on the *right* side of the head, there was a huge hematoma:<\/p>\n

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That raised a lot of alarms with me.\u00a0 But, if you look at the top image of the two just above, you’ll see a bit of hemorrhage in the scalp vein at the right edge of the image.\u00a0 That made me think of yet another needle puncture.\u00a0 Initially, I couldn’t find a needle puncture mark there, but with enough effort, there was a faint mark on the right:<\/p>\n

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Yeah, I know that the lesion is a little out of focus — I accidentally focused on the ear.\u00a0 That’s one of the problems with these tiny little viewports in cameras now.\u00a0 But that little dot *is* a puncture.\u00a0 Thus, this is *also* iatrogenic.\u00a0 Exploration of the bone in the area of the hematoma did not reveal a visually appreciable fracture.<\/p>\n

As always, free for use in lectures, etc. with or without attribution, though attribution is appreciated. Higher resolution images are available if you contact me.<\/p>\n","protected":false},"excerpt":{"rendered":"

This is a case that gave me a little pause.\u00a0 This not-quite-a-year-old infant was found dead at home.\u00a0 The story…<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[99,108],"tags":[59,133,132,134,131,135],"class_list":["post-1968","post","type-post","status-publish","format-standard","hentry","category-forensic-pathology","category-gross-pathology","tag-autopsy","tag-head","tag-hemorrhage","tag-needle-puncture","tag-scalp","tag-subperiostial-hemorrhage"],"_links":{"self":[{"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/posts\/1968","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/comments?post=1968"}],"version-history":[{"count":4,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/posts\/1968\/revisions"}],"predecessor-version":[{"id":1978,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/posts\/1968\/revisions\/1978"}],"wp:attachment":[{"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/media?parent=1968"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/categories?post=1968"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/tags?post=1968"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}