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Chylothorax and child abuse

Objective: Report of an unusual presentation of child abuse in a critical care setting. Design: Case report. Setting: Pediatric intensive care unit of a tertiary care hospital. Patient: A 6-month-old infant. Background: Chylothorax in young children can be a sign of systemic illness or a nondisease entity (idiopathic); however, it also can be the only apparent manifestation of child abuse. Clinical Relevance: Child abuse can present with unusual findings, and the diagnosis is not always apparent. In this and previous case reports of child abuse presenting as chylothorax, the diagnosis of abusive injury was not initially made by the managing clinicians. When abusive injury is in the differential diagnosis of a child's condition, a thorough and complete investigation—including skeletal survey, eye exam by an ophthalmologist, cranial neuroimaging, and consultation with child abuse physicians and child protective services—may be indicated. Conclusion: Before diagnosis of idiopathic chylothorax is made in a young child, clinicians should reexamine the patient and all radiographic studies, searching for findings that may indicate abuse. Further evaluation with a dedicated skeletal survey is suggested.