ABSTRACT
This 2-year-old patient was found to have multiple bruises. Her mother stated that when she came home from work she went straight to the room to check on her and noticed the bruises. The babysitter reported that she fell down the stairs. The child was noted to have extensive bruising to the buttocks and posterior thighs, linear streaks on the back and also on the face, left shoulder, left wrist area and bilateral knees (Images 109a through 109d). https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig109a.jpg"/> https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig109b.jpg"/> https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig109c.jpg"/> https://s3-euw1-ap-pe-df-pch-content-public-p.s3.eu-west-1.amazonaws.com/9780429170423/e1d751c1-a9c7-4bb9-9d59-53742c84031a/content/fig109d.jpg"/>
Is the injury consistent with the history provided?
How would you further evaluate this child?
250This child had multiple bruises in areas not commonly injured by accidents. The location and the extent of bruising were not consistent with falling down the stairs. Bruises in toddlers that are located in atypical areas, such as the trunk, hands or buttocks, should prompt concern for physical abuse which was our major concern in this child. 1
In this child an evaluation for physical abuse was initiated. A complete blood count, liver enzymes and pancreatic enzymes were done. A skeletal survey was done which was normal. A head CT was done due to the bruising of the head and neck and its results were also normal. Due to the liver enzymes being elevated, an abdominal CT was done which was normal. The diagnosis was physical abuse.
