eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Cardiothoracic Surgery
Thoracic Trauma: Multimedia
Updated: Aug 27, 2008
Multimedia
 | Media file 1: Childhood thoracic injury is most appropriately defined as multisystemic injury. Mortality rates vary depending on the associated system. |
 | Media file 2: Posteroanterior chest radiograph shows aspiration of a television diode into the left mainstem bronchus. The child had blunt chest trauma as a belted passenger in a motor vehicle. Early symptoms included expiratory stridor. Retrieval was unsuccessful with a bronchoscope because the spokes of the diode were embedded in the bronchus. Left thoracotomy and bronchotomy were necessary to retrieve the diode. |
 | Media file 3: Subcutaneous emphysema of the chest and neck after tracheal disruption in a 13-year-old adolescent struck by a horse. |
 | Media file 4: CT scan of chest shows a hemothorax on the left side. This can be an insidious, life-threatening injury in children mainly because rib fractures are so rare. |
 | Media file 5: Tension pneumothorax of the right lung after blunt chest trauma. Note the mediastinal shift and deviation of the trachea. |
 | Media file 6: Posteroanterior chest radiographs reveal the natural history of pulmonary contusion after blunt chest trauma. (A) On the day of the injury, multiple opacifications are present and correspond to multiple intraparenchymal hemorrhages. (B) After 2 days of pain management and aggressive chest physiotherapy, substantial resolution of the contusion is seen. |
 | Media file 7: Traumatic asphyxia is produced by a sudden increase in intrathoracic pressure against a closed glottis or compressed tracheobronchial tree. (A) Bronze discoloration and petechiae on the chest, shoulders, and head are typical initial signs. (B) What is frequently overlooked is the potential pathology within the oropharynx, specifically under the tongue. Most of the petechiae should disappear in a few weeks. |
 | Media file 8: Left: Plain chest radiographs depicts a widened mediastinum. Minutes after resuscitation, vital signs were lost in this 12-year-old child, who had a deceleration injury to the chest. Right: Image illustrates what happens when the aorta ruptures. This is frequently a lethal injury despite emergency thoracotomy and aortic cross-clamping. A large tear was found at the level of the ligamentum arteriosum. |
 | Media file 9: Lateral aortograph shows a tear at the level of the ligamentum arteriosum. If the child is stable, aortography is the procedure of choice for evaluating the aorta in the presence of a widened mediastinum. |
 | Media file 10: Posteroanterior chest radiography depicts an elevated left hemidiaphragm and bowel loops on the chest. Bowel sounds were audible in the chest. The injury involved blunt chest trauma at the level of the nipple; this finding enforced the concept that the abdomen in children begins at the level of the nipple. These injuries should be repaired from the abdomen because of the potential for associated intra-abdominal pathology. |
More on Thoracic Trauma |
| References |
References
Cooper A. Thoracic injuries. Semin Pediatr Surg. May 1995;4(2):109-15. [Medline].
Rielly JP, Brandt ML, Mattox KL, Pokorny WJ. Thoracic trauma in children. J Trauma. Mar 1993;34(3):329-31. [Medline].
Tsao K, St Peter SD, Sharp SW, Nair A, Andrews WS, Sharp RJ. Current application of thoracoscopy in children. J Laparoendosc Adv Surg Tech A. Feb 2008;18(1):131-5. [Medline].
Allen GS, Cox CS Jr, Moore FA, et al. Pulmonary contusion: are children different?. J Am Coll Surg. Sep 1997;185(3):229-33. [Medline].
Huh J, Wall MJ Jr, Estrera AL, Soltero ER, Mattox KL. Surgical management of traumatic pulmonary injury. Am J Surg. Dec 2003;186(6):620-4. [Medline].
Karmy-Jones R, Hoffer E, Meissner M, Bloch RD. Management of traumatic rupture of the thoracic aorta in pediatric patients. Ann Thorac Surg. May 2003;75(5):1513-7. [Medline].
Milas ZL, Milner R, Chaikoff E, Wulkan M, Ricketts R. Endograft stenting in the adolescent population for traumatic aortic injuries. J Pediatr Surg. May 2006;41(5):e27-30. [Medline].
Lofland GK, O'Brien JE. Thoracic Trauma in Children. In: Ashcraft KW, Holcomb GW, Murphy JP. Pediatric Surgery. 4th ed. Philadelphia, PA: Elsevier Saunders; 2005:185-200, 215.
Sola JE, Mattei P, Pegoli W Jr, Paidas CN. Rupture of the right diaphragm following blunt trauma in an infant: case report. J Trauma. Mar 1994;36(3):417-20. [Medline].
Shehata SM, Shabaan BS. Diaphragmatic injuries in children after blunt abdominal trauma. J Pediatr Surg. Oct 2006;41(10):1727-31. [Medline].
Peng L, Quan X, Zongzheng J, Ya G, Xiansheng Z, Yitao D. Videothoracoscopic drainage for esophageal perforation with mediastinitis in children. J Pediatr Surg. Mar 2006;41(3):514-7. [Medline].
Further Reading
Keywords
thoracic trauma, multisystem injury, blunt injury, airway obstruction, airway injury, lung injury, chest wall injuries, open pneumothorax, tension pneumothorax, hemopneumothorax, flail chest, widened mediastinum, aortic dissection, cardiac tamponade, pulmonary contusion, ruptured tracheobronchial tree, ruptured diaphragm, esophageal perforation, myocardial contusion, chest injury, motor vehicle accident, hypovolemia, shock, foreign body aspiration, subcutaneous emphysema, video-assisted thoracic surgery, VATS, seizures, cardiac arrest
