Paediatric chest trauma (part 1) — Initial Lethal Injuries

Kerr, Maya; Maconochie, Ian

doi:10.1177/1460408608096284

Cited by 7 publications

(6 citation statements)

References 37 publications

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“…Computed tomography scanning of the chest will yield further information if available. However, most paediatric chest trauma can be managed with a tube thoracostomy and supportive measures alone as in our case [3] , [7] .…”

Section: Discussionmentioning

confidence: 92%

“…Chest trauma is the second leading cause of paediatric trauma death [3] , [7] . Children have pliable rib cages, which make rib fractures, even in cases of extensive chest trauma, rare.…”

Section: Discussionmentioning

confidence: 99%

“…Initial management of chest trauma follows Advanced Trauma Life Support (ATLS) guidance. Standard anterior-posterior (AP) chest radiographs provide a low-cost screening tool and will be abnormal in the majority of children with significant injuries [7] . Computed tomography scanning of the chest will yield further information if available.…”

Section: Discussionmentioning

confidence: 99%

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Traumatic chylothorax in a young child: Case report and management

Jahn

Frost

2017

African Journal of Emergency Medicine

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IntroductionA chylothorax is an uncommon feature of paediatric chest trauma.Case reportWe report a case of traumatic chylothorax following blunt chest trauma in an eight year-old girl with polytrauma after being hit by a motor vehicle. She was initially found to have a bilateral frontal skull fracture extending into the left parietal area, pulmonary contusions, left posterior rib fractures, left clavicular fracture and a degloving injury of her left foot. On the fifth day of her admission she developed progressive dyspnoea with signs of a pleural effusion, which was confirmed radiologically and drained by tube thoracostomy. Biochemical analysis confirmed chylothorax, which was managed conservatively with a fat free diet. The chest tube was removed after it stopped draining over 20 mL per 12 hours and she made a full recovery.DiscussionInitial management of chylothorax is conservative with tube thoracostomy drainage and fat free diet. Traumatic chylothroax is a rare complication following chest trauma and can take days to develop and to become clinically apparent. It is therefore important to be vigilant for potential late complications in blunt chest trauma in children, especially if there are extensive rib fractures, a sign of major transmission of force to the thorax.

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Section: Discussionmentioning

confidence: 92%

“…Chest trauma is the second leading cause of paediatric trauma death [3] , [7] . Children have pliable rib cages, which make rib fractures, even in cases of extensive chest trauma, rare.…”

Section: Discussionmentioning

confidence: 99%

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Traumatic chylothorax in a young child: Case report and management

Jahn

Frost

2017

African Journal of Emergency Medicine

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“…The chest wall of children is thinner than in adults and there is a higher proportion of cartilage, so the ribs are more elastic and rib fractures are less likely than in adults. However, the underlying heart and lungs are then more vulnerable and injuries are often disproportionally severe compared with the visible surface injury [2] and compared with the same injury in adults [3] . Even tracheobronchial rupture is more commonly seen in children than in adults and more often on the right side because of the position of the bronchus just in front of the spine [4] .…”

Section: Discussionmentioning

confidence: 99%

Osseous pinch mechanism in traumatic rupture of aorta and the left main bronchus

Lesbo¹,

Andersen²,

Nielsen³

et al. 2011

Grand Rounds

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We report an unusual case of traumatic aortic rupture and lesion of the left main bronchus after blunt chest trauma in an 8-year-old otherwise healthy boy. The trauma mechanism was severe compression of the thoracic cavity underneath a heavy object without a deceleration component. The visceral lesions were disproportionally severe compared with the surface injury. This case shows the possibility of an osseous pinch after severe compression of the chest and the importance of meticulous examination and monitoring of the patient for complications afterwards.An 8-year-old boy was transferred to our institution with an aortic rupture after being caught under a tilting soccer goal frame during a match. He had been unconscious for a few moments, but on arrival at the local hospital the boy scored the full 15 points on the Glasgow Coma Scale. A left-sided tension pneumothorax was treated with a chest tube. A computerized tomographic (CT) scan showed bilateral contusions of the lungs, a small residual pneumothorax, a pneumomediastinum and a left-sided mediastinal hematoma with a possible aortic lesion at the level of the aortic isthmus, just distal to the origin of the left subclavian artery in the CT slices (Fig. 1a,b) and in a full reconstruction of the thoracic aorta (Fig. 2). The boy was transferred to our institution for surgery, awake and in a circulatory and respiratory stable condition. Because of the pneumomediastinum and the CT findings, we suspected an oesophageal or bronchial lesion This paper is available online at http://www.grandrounds-e-med.com. In the event of a change in the URL address, please use the DOI provided to locate the paper.

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“…The six lethal injuries are all immediately life threatening and need to be considered and diagnosed or excluded in the primary survey. These were reviewed in detail in part 1 of this paper along with chest injury in non-accidental injury (Kerr Maconochie, 2008). This article reviews the six hidden chest injuries.…”

Section: Introductionmentioning

confidence: 99%

Paediatric chest trauma (part 2) — Hidden Injuries

Kerr

Maconochie

2008

Trauma

Self Cite

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Chest trauma is the second greatest cause of mortality from trauma, a leading cause of death in children over the age of one. Prompt diagnosis can be difficult as the underlying thoracic injuries are often disproportionately severe compared to the visible surface injury and symptoms may not appear for several hours. Diagnosis are easily underestimated, delayed or missed. This is the second of a 2 part article reviewing Paediatric chest trauma and its current management. The injuries are usefully classified into 6 lethal injuries that need excluding in the primary survey and 6 hidden injuries that must be considered in the secondary survey. The 6 lethal injuries are covered in the first part of this article along with biomechanics and mechanisms of injury. This article looks in depth at the 6 hidden injuries, along with a review of chest trauma in non-accidental injury.

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Paediatric chest trauma (part 1) — Initial Lethal Injuries

Cited by 7 publications

References 37 publications

Traumatic chylothorax in a young child: Case report and management

Traumatic chylothorax in a young child: Case report and management

Osseous pinch mechanism in traumatic rupture of aorta and the left main bronchus

Paediatric chest trauma (part 2) — Hidden Injuries

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