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previously visited 070313 SUDDEN NEONATAL DEATH WITH BRAIN PROFOUND HYPOXIA AND RENAL CORTICAL NECROSIS certified Random Case
Authored By: pedrad CSH, Radiologist, Chung Shan Medical University Hospital, Taiwan.
Patient: 3 week old 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:[small]mediumlargeas-submittedimages only

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
Images:[small]mediumlargeas-submittedimages only
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.
Comments: post a comment

Fine renal cortical calcification after cortical necrosis may 

be seen on plain radiographs.

They usually be not seen until at least some weeks.

The "eggshell" calcification may be considered as a

pathognomonic finding for renal cortical necrosis.

By Dr. Tsao

--pedrad CSH, 2007-03-15 22:57:04
Additional Details:

Case Number: 8441416Last Updated: 07-22-2007
Rating:

2 ratings
Anatomy: Cranium and Contents   Pathology: Vascular
Modality: CT, Conventional Radiograph, PhotographAccess Level: Readable by all users
ACR: 138.78Contained in: Child Abuse, lorimaya
Case has been viewed 3912 times.
certified Certified by Dr Phillip Silberberg, Children's Hospital Omaha on 07-22-2007

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