Syndrome d’asphyxie traumatique ou syndrome de Perthes : à propos de deux observations pédiatriques

Traumatic asphyxia in the young: report of two cases and literature review

Background

Traumatic asphyxia, also called masque ecchymotique, Ollivier’s syndrome, and Perthes syndrome, is a rare but serious form of chest trauma described for the first time by Ollivier in 1837. The purpose of this study is to report our experience with two cases of traumatic asphyxia and discuss their management in view of the relevant literature.

Results

During a 6-year period, the author treated 2 cases of traumatic (crush) asphyxia in a local teaching hospital. The two patients were males, aged 20 and 30 years and were crushed beneath their vehicles. The presenting symptoms and signs were irritability, dyspnea, cervicofacial cyanosis, petechiae, and sub-conjunctival hemorrhages. The second patient suffered multiple rib fractures, hemopneumothorax, pulmonary contusion, vertebral fracture, and paraplegia. Negative surgical exploration for suspected cardiac tamponade was performed in the first case, while the second was managed conservatively.

The first patient survived whereas the second succumbed because of the associated injuries.

Conclusions

Due to its widespread lesions, traumatic asphyxia should be looked upon as a systemic syndrome. Timely accurate diagnosis and supportive treatment save the majority of patients with traumatic asphyxia. In this rare syndrome, death may result from asphyxia secondary to thoracic compression or from the associated injuries.

A retrospective study of 51 pediatric cases of traumatic asphyxia

Background

Traumatic asphyxia (TA) is a rarely reported disease characterized as thoraco-cervico-facial petechiae, facial edema and cyanosis, subconjunctival hemorrhage and neurological symptoms. This study aimed to report 51 children of TA at the pediatric medical center of west China.

Methods

Scanned medical reports were reviewed and specific variables as age, sex, cause of injury, clinical manifestations and associated injuries were analyzed using SPSS 25.0.

Results

The average age of patients was 5.3 ± 2.9 (1.3–13.2) year-old. Thirty (58.8%) were boys and 21 (41.2%) were girls. Most TAs occurred during vehicle accident, object compression and stampede. All patients showed facial petechiae (100.0%, CI 93.0–100.0%), 25 (49.0%, CI 34.8–63.2%) out of 51 presented with facial edema, 29 (56.9%, CI 42.8–70.9%) presented with subconjunctival hemorrhage, including bilateral 27 and unilateral 2. Six patients had facial cyanosis (11.8%, CI 2.6–20.9%). Other symptoms were also presented as epileptic seizure, vomiting, incontinence, paraplegia, etc. The most frequent companion injury was pulmonary contusion (76.5%, CI 64.4–88.5%). Other companion injuries included mediastinal emphysema, fracture, cerebral contusion and hemorrhage, hypoxic-ischemic brain injury, abdominal organ contusion, mastoid hemorrhage, hematocele of paranasal sinuses, spinal cord injury, hepatic insufficiency, myocardial injury and retinal hemorrhage and edema. Treatment was mainly supportive. No death occurred in our study. The prognosis is rather good if without damage of central nervous system.

Conclusion

TA could bring out multiple symptoms, among which retinal hemorrhage and edema, spinal cord injury and viscera impairment have been less observed. Comprehensive physical and auxiliary examination should be performed considering TA. Its prognosis is rather good with focus on life-threatening complications.

Comparison of autopsy findings and injury severity scores in deaths due to traumatic asphyxia (perthes syndrome)

Traumatic asphyxia is a rare clinical syndrome usually caused by sudden and severe thoracic and/or thoracoabdominal compression. It presents with craniofacial cyanosis, petechiae, and subconjunctival haemorrhages. The present study employed a postmortem retrospective methodology to analyse autopsy findings and accompanying injuries in cases of death due to traumatic asphyxia. Four years of case files from a morgue department at a forensic medicine institute were searched and 53 cases of lethal traumatic asphyxia were found. These cases were then classified into groups and compared using the Injury Severity Score (ISS) and New Injury Severity Score (NISS) indices to measure trauma.

RESULTS

The individuals had died due to occupational (n = 28; 52.8%), farm (n = 10; 18.9%), traffic (n = 9; 17.0%) or household (n = 6; 11.3%) accidents. At the external examination, conjunctival petechiae (60.4%) and petechiae on the face/neck (52.8%); at the autopsy, subpleural petechiae (58.5%) and petrous ridge hemorrgahe (without skull base fracture) (56.6%) were the most common findings. A finding of petrous ridge hemorrgahe was very common in the cases without any accompanying injuries (Group A in which mean Injury Severity Score was 0.83 ± 0.98). Traumatic asphyxia is usually suspected from the given circumstances before an autosopy is performed. In cases without hospitalisation, any of the following signs may lead the physician to diagnose traumatic asphyxia as the cause of death: petechiae on the upper parts of the body and conjunctiva, petechiae on serous membranes (including subpleural regions), signs of petrous ridge haemorrhage without skull base fracture.

[Perthes syndrome secondary to an asthma attack: A case report in a 15-year-old child]

Perthes syndrome, or traumatic asphyxia syndrome, is a rare clinical entity, associating cyanosis, cervicofacial petechiae and subconjunctival hemorrhage. It is usually secondary to chest trauma, but can occur in any situation of abrupt rise in intrathoracic pressure with closed glottis. In this paper, we present a case of Perthes syndrome that triggered an asthma attack for a child during surgery.

A Case of Traumatic Asphyxia due to Motorcycle Accident

Background. Perthe's syndrome (traumatic asphyxia) is rare, which is caused by sudden compressive chest trauma and characterized by subconjunctival hemorrhage, facial edema, craniocervical cyanosis, and petechiae on the upper chest and face and should always be kept in mind as a possible complication of injuries of the chest and abdomen. Case Report. In this case report a 36-years-old male patient brought to the emergency room due to thorax trauma related to motorcycle accident was discussed. Distinct cyanotic, edematous, and multiple petechiae were present on the face, neck, and upper thorax regions of the patient. Bilateral subconjunctival hemorrhage was determined. Conclusion. Treatment for traumatic asphyxia is supportive and patient recovery is related to the generally associated injuries. Prognosis of the patients is quite good with effective and timely treatment.