Suction pump injuries mimicking child abuse
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DIFFERENTIAL DIAGNOSIS
Suction pump injuries mimicking child abuse Karen J. Heath1,2 • Roger W. Byard1,2
Accepted: 21 May 2015 Ó Springer Science+Business Media New York 2015
Case report
Discussion
A five-year-old boy was at home in the care of his father. According to the father’s testimony the boy had allegedly been playing alone in the kitchen when he appeared with injuries to his face. The lesions consisted of two partly overlapping semicircular red–purple bruises on the right cheek. Each bruise measured 25 mm in diameter. The upper margins were well defined with indistinct lower margins over the curve of the cheek (Fig. 1). Both fine and coarse petechial hemorrhages were present. The explanation offered for the injuries was that the boy had been playing with a wine bottle vacuum sealer pump and had put it against his face and manually pumped it twice. No other injuries were present and an area of green discoloration adjacent to the right eyebrow had been caused earlier in the day by a green marker pen. The boy was otherwise well with no underlying illnesses except for mild eczema. Examination of the vacuum sealer revealed a plastic base measuring 25 mm in diameter (Fig. 2) which exactly matched the dimensions of the facial injuries. It was concluded that the paired semicircular injuries had been caused by the bottle vacuum pump, with suction creating petechial hemorrhages.
Injuries to the face in young children may arise from accidents or may indicate deliberately inflicted trauma. In accidents occurring in domestic situations bruises tend to be small and situated over bony prominences, whereas inflicted injuries are often multiple and bilateral with a cranio-facial predilection. ‘‘Black eyes’’ and bruised lips result from either direct blows or from being thrown or dropped, and may be associated with dental trauma and lacerations and bruises to the tongue, gums, and palate [1, 2]. These may be associated with injuries to the eyes such as subconjunctival hemorrhages or damage to the globe. Bruises, particularly in the very young, are associated with a significant risk of serious inflicted injury [3]. In the reported case the presence of semicircular injuries to the face raised the possibility of bite marks as these may appear as round to oval suction lesions with petechial hemorrhages, i.e., so-called ‘‘love bites.’’ The cheeks are frequently sites of infliction and petechiae were noted in both of the areas of injury. The narrow diameter was not, however, in keeping with an adult dental arcade, and the features, including the lack of lacerations, were also not those of an animal bite. There were also no associated linear abrasions from dragging of teeth over the skin surface. Patterned injuries may be of particular significance as they may reveal the morphology of the object that has struck a child or against which a child has impacted. While the possibility of impact with an object could not be excluded based simply on the appearance of the injuries in this case, the history given by the child and the p
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