Case 19

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A 2.5-year-old boy presents with a history of vomiting at home for the last 24 hours. He was previously healthy except for frequent bruises to his face, chest and abdomen. He recently fell down two steps at the front of his home. His physical exam reveals a tender, distended abdomen. There are bruises on his anterior chest, lower back and forehead, but the abdominal skin is not bruised. His abdominal radiograph reveals the finding demonstrated here:

Chest X-Ray, further description below

Accessible Version

A chest and upper abdominal radiograph demonstrating decreased density under the diaphragm, bilaterally.

What is the most likely cause of this finding?

A. Abdominal trauma secondary to the stairway fall.

B. A bowel perforation due to inflicted trauma.

C. Pneumoperitoneum due to a perforated appendicitis.

D. An intussusception associated with Henoch-Schonlein Purpura.