Abstract
Total anomalous pulmonary venous return (TAPVR) is a rare congenital cardiac defect that may present with cyanosis, cardiac failure and failure to thrive in infancy. TAPVR type 1 has a typical radiographic appearance of the heart termed the snowman. We present a case of an infant with TAPVR type 1 with injuries in keeping with non-accidental injury (NAI) to highlight that children with chronic diseases are at greater risk of this kind of injury and that radiographic evaluation of the chest in cardiac disease plays a role beyond demonstrating the heart and vasculature of the chest.
Highlights
A 2-month-old boy presented to the paediatric casualty unit with a fluctuating level of consciousness after allegedly falling from a bed
On admission to the paediatric ward, hospital records identified the patient as belonging to the cardiac clinic for a cyanotic heart disease with a diagnosis of total anomalous pulmonary venous return (TAPVR) type 1
TAPVR results from the failure of pulmonary veins to connect to the left atrium
Summary
A 2-month-old boy presented to the paediatric casualty unit with a fluctuating level of consciousness after allegedly falling from a bed. A CT brain scan (Figs 1 and 2) demonstrated a subarachnoid bleed associated with a right linear parietal skull fracture and an overlying scalp haematoma. On admission to the paediatric ward, hospital records identified the patient as belonging to the cardiac clinic for a cyanotic heart disease with a diagnosis of total anomalous pulmonary venous return (TAPVR) type 1. Further investigation into the history revealed inconsistencies with the mechanism of injury and the suspicion of non-accidental injury (NAI) arose. A chest X-ray (Fig. 3) demonstrated the classic snowman sign, in keeping with TAPVR type 1. The chest X-ray showed multiple, predominantly left-sided, posterior and lateral rib fractures with callus formation.
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