Case Report: Neonate With Stridor and Subcutaneous Emphysema as the Only Signs of Physical Abuse

Abstract

A stridulous, dysphonic cry with no external signs of trauma is a unique and unusual presenting sign for physical abuse. We report a previously healthy neonate with unremarkable birth history and medical history who presented with stridor and hypopharyngeal perforation due to physical abuse. This case highlights the need for further evaluation for traumatic injuries in the setting of unexplained new-onset stridor and consideration of physical abuse in the differential diagnosis.

Pneumomediastinum: A Rare Presentation of Inflicted Injuries in Infants

“…Smaller case reports in the literature have demonstrated similar findings of newborns presenting with pneumomediastinum, 2 iatrogenic oropharyngeal injury, 14 15 and child abuse. 16 The ages of presentation ranged from 2 weeks to 10 months of age with a median age of 2 months of age.…”

“…3,4,[11][12][13] However, if a pneumomediastinum is identified in an otherwise term healthy infant, and other relevant differentials have been excluded, the possibility of airway or esophageal injury secondary to physical abuse should be further investigated. 2 We identified three cases that presented to our institution with findings of pneumomediastinum, oropharyngeal injury, and confirmed physical abuse. We utilized PubMed, Scopus, Ovid MEDLINE, and Google Scholar databases to query patients presenting oropharyngeal injuries, pneumomediastinum secondary to intentional injury.…”

“…1 In infants, it is caused by injury to the esophagus, trachea, bronchi, or alveoli. 2 Airway injuries are the most common cause for pneumomediastinum in infancy, and can be seen in a variety of conditions, such as perinatal causes (prematurity, induced labor, vacuum extraction, cesarean section with aspiration of amniotic fluid, meconium or blood, treatment for lack of surfactant), resuscitation, pneumonia, or barotrauma from mechanical ventilation. [3][4][5][6][7][8][9][10] On the contrary, esophageal injuries are caused by operative procedures, iatrogenic instrumentation, foreign bodies, or even physical abuse.…”

“…3 4 11 12 13 However, if a pneumomediastinum is identified in an otherwise term healthy infant, and other relevant differentials have been excluded, the possibility of airway or esophageal injury secondary to physical abuse should be further investigated. 2…”

Pharyngeal trauma: When to suspect physical abuse

“…Paediatric pharyngeal trauma frequently occurs after falls or other accidents. Although most cases are minor, some can have life‐threatening complications such as subcutaneous emphysema, pneumomediastinum and carotid artery injury (Bansal & Abramo, 1997; Brietzke & Jones, 2005; Byramji et al, 2009; Chauhan et al, 2006; Hennelly et al, 2010; Narchi, 2003; Ostwani et al, 2015; Ramnarayan et al, 2004). Subcutaneous emphysema can result from trauma of the pharynx, trachea and oesophagus.…”