Histological demonstration of haemosiderin deposits in lungs and liver from victims of chronic physical child abuse

Abstract

In the context of chronic physical child abuse, two entities have been described based on macroscopical and radiological criteria: the battered baby syndrome and the shaken baby syndrome. However, in some autopsy cases, clinico-radiological information may not be available. In these cases, histological examinations are necessary to look for sequelae of repeated haemorrhages, particularly in organs likely to have suffered traumatisms such as the lungs, or in organs belonging to the mononucleated macrophage resorption system, such as the liver and the spleen. We examined a series of 15 young children who died from proven chronic child abuse and compared them with 15 sex and age-matched control subjects who died from natural causes with no history of child abuse. Using Perl's stain for iron, we identified haemosiderin deposits in pulmonary, hepatic and splenic samples and the deposits were evaluated qualitatively and quantitatively. Haemosiderin deposits were significantly (P < 0.001) more abundant in the lungs and liver of the chronic abuse victims than in those of the control subjects. However, they were not significantly more abundant in the spleens of child abuse victims than in controls. We conclude that haemosiderin deposits in lungs and liver could be proposed as a marker for chronic physical child abuse. This study stresses the importance of systematic histological examination to look for pulmonary and hepatic haemosiderin deposits in cases in which chronic child abuse is suspected.

Three subsequent infanticides covered up as SIDS

“…This suspicion was confirmed by the subsequent police investigations and finally by the perpetrators' confession. In our cases no siderophages were present in the pulmonary tissue which can be explained by the fact that the homicidal acts were obviously not preceded by any episodes of near-suffocation, as they occur, for example, in the Munchausen syndrome by proxy [11,27,30].…”

“…Significant findings in connection with deaths from asphyxia due to obstruction of the respiratory passages are acute pulmonary emphysema in combination with intra-alveolar pulmonary edema, fresh intra-alveolar hemorrhages involving >5% of the pulmonary tissue ("hemorrhagic-dysoric syndrome"), and occasionally microembolism syndrome with migration of bone marrow cells into the pulmonary circulation [6,9,10,16,41,44]. In cases of primary survival intraalveolar siderosis can be found [5,11,30]. Not only in infants is the latter regarded as an important sign of previous near-suffocation [1,11,26].…”

“…In cases of primary survival intraalveolar siderosis can be found [5,11,30]. Not only in infants is the latter regarded as an important sign of previous near-suffocation [1,11,26].…”

Suffocation and poisoning?the hard-hitting side of Munchausen syndrome by proxy

“…-In nearly all cases several up to many hospital admissions had occurred before a forensic medical or toxicological investigation was initiated. -All our cases were detected in only 4 out of 15 paediatric hospitals that exist in our region, although many more paediatric departments had been involved in the treatment of the children.…”

“…Apparent lifethreatening events (ALTE) also turned out to be caused by MSBP [18]. The histological finding of haemosiderinladen macrophages in the lungs or the liver provides supportive evidence of deliberate upper airway obstruction [6,15,27].…”