Pneumomediastinum and Pneumothorax From Blunt Cervical Trauma in Children

Abstract

Minor blunt cervical injuries in children are relatively common occurrences leading to serious sequelae in only rare circumstances, yet sufficient impact of even a seemingly minor event may lead to a significant posterior tracheal wall laceration, resulting in pneumomediastinum with or without pneumothorax. Three cases demonstrate how the mechanism of injury does not always match either the severity of initial presentation or the consequent necessary level of emergent management. Pneumomediastinum without pneumothorax often can be treated conservatively; however, the onset of massive pneumomediastinum and pneumothorax may necessitate both tracheotomy and tube thoracostomy as initial treatment.

Pediatric Neck Trauma Causing Massive Subcutaneous Emphysema

“…Laryngotracheal reconstruction has been described for severe injuries and near transection. 3 A graded stepwise approach to children sustaining blunt neck trauma is essential. Authors have described a thorough algorithm that emphasizes cervical spine stabilization and evaluation in conjunction with airway control.…”

“…[1][2][3][4] Most reports describe blunt anterior neck trauma resulting in posterior, longitudinal tears of the trachea. This occurs because blunt force to the cervical trachea crushes it against the rigid cervical spine, stretching and tearing the posterior membranous wall.…”

Pneumomediastinum: A rare presentation in Emergency Department following blunt trauma to neck during a football match

“…Four of them were children, and one was a young adult, who became symptomatic within 10 min after the injury. 5,9 In pneumomediastinum air can come from alveolar, bronchial or oesophageal rupture. This leakage can occur spontaneously without any history of obvious trauma or positive pressure ventilation.…”

Management of blunt tracheal trauma in children: a case series and review of the literature

“…Blunt tracheal lesions can be the result of different mechanisms: external force applied directly to the anterior neck, with flattening of the cartilage and transmission of force to the posterior wall, resulting in linear lesions (cases 1-4); traction exerted on the carina; compression of the chest with closed glottis (case 5); or rapid deceleration, resulting in shearing forces at the posterior areas of fixation [2,3,12,16,18,21,22].…”

“…In case of an incomplete rupture (less than one third of the circumference) or of a longitudinal posterior tear with good adaptation of the wound margins, the patient can be managed conservatively, with close observation [2,3,10,16,22]. Treatment with antibiotics is usually instituted, since the anatomic structures are disrupted and secondary bacterial infection is likely to occur [4,10,15,16,21]. Group 2 injuries usually require intubation with tube placement distal to the injury, acting as a stent.…”