Dramatic case of Dog bite in a young child

 

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Doctor's Information

Name : Morteza
Family :Sanei Taheri
Email : This email address is being protected from spambots. You need JavaScript enabled to view it.
Resident : Samira Shahhamzei

 

Patient's Information

Gender : Male
Age : 9

 

Case Section

Head & Neck Imaging

 

Clinical Summary

A 9 years-old boy was attacked by 8 dogs

 

 

Imaging Procedures and Findings

In X-ray soft tissue swelling of prevertebral soft tissues, severe emphysema of neck and pneumo mediastinum and distortion of upper air ways with reverse lordosis were seen. In gastrographin swallow heterogenous collection of contrast material were seen in lower part of sinus piriformis and glottis in lateral view due to fistula formation and leak of contrast material in left lateral soft tissue of neck. In CT scan severe soft tissue swelling with emphysema and pneumomediastinum, deviation of trachea to right, air densities in parapharyngeal spaces of both sides, prevertebral and around carotid, leak of contrast material in hypopharynx and proximal part of esophagus were seen.

 

Discussion

Although this should be a problem for the public health authorities, few measures seem to have been taken to prevent this kind of accident. This problem is especially serious because it is mainly young children who are at risk. In all the reported studies, most cases involved young children, who also presented with the most substantial wounds. It is a fact that children are invariably attacked around the neck and facial area. Perforation of hypopharynx and sinus priformis is a life-threatening event requiring prompt diagnosis and treatment. More than half of cases are related to esophageal instrumentation. Bleeding can be profuse, and infection is a great risk. Plain films demonstrate subcutaneous, cervical, or mediastinal emphysema within 1 hour of perforation. Chest radiographs may show a widened mediastinum and pleural effusion or hydropneumothorax if esophageal perforation is associated. Contrast studies should be performed initially with low-osmolar water-soluble agents .The key finding is focal or diffuse extravasation of contrast outside the digestive tract. CT demonstrates fluid collections, extraluminal contrast, and air in the neck and mediastinum.

 

Final Diagnosis

Dramatic case of Dog bite

 

References

Brant WE, Helms CA. Fundamentals of Diagnostic Radiology, 3rd edition. P814 Ghandi RR, Liebman MA, Stafford BL, et al. Dog bite injuries in children: a preliminary survey. Am Surg 1999; 65: 863??864

 

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