Traumatic asphyxia with diaphragmatic injury: a case report

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.

Therapeutic efficacy for traumatic asphyxia with a focus on cardiac arrest

Aim

To investigate the clinical features of traumatic asphyxia, specifically the presence of cardiac arrest and therapeutic efficacy. This review will be useful for future emergencies.

Methods

Sixteen traumatic asphyxia cases from our hospital between April 2007 and March 2019 were reviewed and divided into three groups: those experiencing cardiac arrest at the time of rescue (group A, six cases), those experiencing cardiac arrest after rescue (group B, five cases), and those who did not experience cardiac arrest (group C, five cases).

Results

All cases had abnormal findings in the skin or conjunctiva. The total mortality rate reached 56%. Among the 11 cases in groups A and B that resulted in cardiac arrest, 10 had an Injury Severity Score of 16 or higher and an Abbreviated Injury Scale score in the chest of 3 or higher. The patients' injuries included pneumothorax, flail chest, and pericardial hematoma. The heartbeat was restarted in seven cases, and two cases completely recovered.

Conclusion

In some traumatic asphyxia cases, the treatment course was relatively effective even with cardiac arrest; thus, life support efforts should not be spared in such cases.

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.