Paediatric chest trauma (part 2) — Hidden Injuries

Kerr, Maya; Maconochie, Ian

doi:10.1177/1460408608096289

Cited by 3 publications

(2 citation statements)

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“…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] . The lesion in this case was found at the most central part of the left main bronchus.…”

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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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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“…The second article of this chest trauma review covers the potentially life-threatening hidden six chest injuries in trauma which need to be considered during the secondary survey (Kerr and Maconochie, 2008).…”

Section: Discussionmentioning

confidence: 99%

Paediatric chest trauma (part 1) — Initial Lethal Injuries

Kerr

Maconochie

2008

Trauma

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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 is easily underestimated, delayed or missed. This is a two part article reviewing paediatric chest trauma and its current management. The injuries are usefully classified into six lethal injuries that need excluding in the primary survey and six hidden injuries that must be considered in the secondary survey. The first article reviews paediatric anatomy and biomechanics, and mechanisms of injury with a view to improving the awareness and understanding of the unique response of children to thoracic trauma. This is followed by an in depth review of each of the six lethal injuries. The subsequent article reviews the six hidden injuries as well as the role of chest trauma in non-accidental injury.

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