Aortic Disruption Associated with L2-L3 Fracture-Dislocation in a Case of Child Abuse

Abstract

The literature pertaining to child abuse indicates that very few victims (<3%) present with a spine injury1,2. A comprehensive review of the literature revealed a limited number of references to pediatric aortic rupture and only two instances of aortic rupture associated with spinal fracture3,4. All of the reports of pediatric aortic disruption described the injuries as being secondary to severe trauma due to a fall or a motor-vehicle accident. The purpose of this report is to describe a case of fatal aortic disruption and define the mechanism of injury in a child who presented with an L2-L3 fracture-dislocation. A girl who was three and a half years old was transported to the hospital emergency department by paramedics after she had presumably drowned in a children’s wading pool. Resuscitative efforts were administered en route and in the hospital emergency room but were unsuccessful, and the child was pronounced dead on the same day. The police investigated the death as a suspected accidental drowning, and an autopsy was performed the following day under a coroner’s warrant. At autopsy, external examination revealed minor abrasions and contusions scattered on the face and head, but there was no external evidence of blunt force injury to the torso. On internal examination, there was acute traumatic transection of the abdominal aorta just distal to the level of the origin of the inferior mesenteric artery with massive retroperitoneal hemorrhage. This was associated with a complete fracture-dislocation of the lumbar spine through the L2-L3 intervertebral disc with a completely disrupted anterior longitudinal ligament, hematomas within the paraspinal muscles, and an epidural hematoma around the caudal aspect of the spinal cord (Fig. 1). Histological examination of soft tissue from around the vertebral fracture site showed reparative changes with fibrosis consistent with prior …