More Lessons for the Clinician: #2

Periodically we receive comments from readers about specific cases that are presented in Index of Suspicion. These observations offer opportunities to pass along additional clinical pointers. Some of the comments come through the reply forms that readers send in and reach the editors anonymously. Others arrive directly from specific readers.

The presence of a liver laceration in a 2-year-old boy was ascribed to a spanking that his mother later admitted she had administered (

). A reader writes, “Please explain the mechanics of spanking as causing liver damage, ie, trauma to buttocks causing significant pressure to the liver to result in laceration. This clinical presentation left the readers without a scientific cause: effect relationship.” The author replies, “I did not realize that the use of the term ‘spanking’ would make a reader question a cause:effect relationship. As one of my attendings...