070313 SUDDEN NEONATAL DEATH WITH BRAIN PROFOUND HYPOXIA AND RENAL CORTICAL NECROSIS

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070313 SUDDEN NEONATAL DEATH WITH BRAIN PROFOUND HYPOXIA AND RENAL CORTICAL NECROSIS

Contributed by: pedrad CSH, Radiologist, Chung Shan Medical University Hospital, Taiwan.

Patient: male

History: Sudden death (unknown etiology).
Post cardio pulmonary resuscitation (CPR) for 20-30 minutes.
Then, transfered to our hospital.
Multiple ecchymoses on face and trunk.
Suspicious child abuse or disseminated intravascular coagulation (DIC).
Coma scale in our hospital: 2T
Lower WBC (1930 /mm3)
Lower Hb (9.2 gm/dl)
Lower Plat (36000 /mm3)
APTT prolong (>120")
High LDH (2710 IU/L)

Images:

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Fig. 1: Photo on hospital day 1


Fig. 2: Non-enhanced CT on hospital day 2


Fig. 3: Non-enhanced CT on hospital day 2


Fig. 4: Non-enhanced CT on hospital day 2


Fig. 5: Non-enhanced CT on hospital day 2


Fig. 6: Non-enhanced CT on hospital day 2


Fig. 7: Non-enhanced CT on hospital day 2


Fig. 8: Non-enhanced CT on hospital day 2


Fig. 9: KUB on different days


Fig. 10: KUB on hospital day 65

Findings:

Photo (Fig.01):
Multiple ecchymoses on face and trunk.

CT scan of brain without IV contrast (Fig.02-08):

1. Diffuse decreased gray matter densities with partial spare of
   cerebelum (reversal sign) and decreased gray-white matter
   differentiation and effacement of sulci and cisterns,
   in favor of profound hypoxia but nature to be determined.
2. Gyriform high densities in cerebral cortex, suggesting
   hemorrhagic cortical necrosis due to ischemia.
3. Small subarachnoid hemorrhage in interpeduncular cistern.
4. Some intraventricular hemorrhage in bilateral occipital horns.
5. No detectable fracture in skull.

KUB (Fig.09,10):
1. Normal KUB on 2006.12.07.
2. Increased opacity in abdomen, due to renal failure under
   peritoneal dialysis.
3. Eggshell-like calcification occupied in left renal fossa
   (yellow circle on Fig.09), in favor of renal cortical
   necrosis with calcification due to renal vascular
   insufficiency. (previous CPR 2-30 minutes).

Diagnosis: Sudden neonatal death with brain profound hypoxia and renal cortical necrosis.

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Additional Details:

Case Number: 8441416Last Updated: 03-15-2007
Anatomy: Cranium and Contents Pathology: Vascular
Modality: CT, Conventional Radiograph, PhotographAccess Level: Readable by all users
ACR: 138.78

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