Traumatic aortic transection in a child

The report presents the rare occurrence of aortic transection in a child following blunt trauma, highlights the need for suspicion of this lethal condition in pediatric patients sustaining blunt deceleration injury, and discusses its surgical management.     

Traumatic lung herniation in a child]

Traumatic lung hernia of the chest wall is unusual in pediatric patients. Most acquired traumatic lung hernia occur at the site of injury or on the anterior parasternal chest wall because the external intercostal muscle is absent from the cost cartilaginous junction to the sternum. A five-year-old girl presented with such a hernia after severe blunt trauma to her right torso. A chest radiograph, immediately after the injury and a CT scan showed lung herniation. She was treated surgically by direct repair of the chest wall defect. The recovery proceeded without complications. With early identification and appropriate surgical or video-assisted repair, symptomatic pulmonary hernia can have an excellent prognosis and very low probability of recurrence.     

Intraperitoneal bladder rupture in a battered child

Visceral manifestations of child abuse are less commonly diagnosed than are the characteristic skeletal injuries. We describe a child with intraperitoneal bladder rupture caused by blunt abdominal trauma. Intraperitoneal resorption of the extravasated urine led to laboratory evidence of renal failure.     

Traumatic pneumorrhachis in a child: case report

Traumatic pneumorrhachis (air within the spinal canal) is a very rare entity and rarer in the pediatric population. We report a 7-year-old polytrauma patient with subarachnoid pneumorrhachis and discuss the causes, mechanism, and implications of this condition.     

Rupture of the right hemidiaphragm due to blunt trauma in children: a diagnostic dilemma

 The diagnosis of right-sided diaphragmatic rupture (RDR) due to blunt abdominal trauma is often missed in the acute setting, especially in the absence of other thoracoabdominal injuries. We describe two such children. The problems associated with the diagnosis and management of RDR are discussed to emphasize the need to have a high index of suspicion for this entity.     

Traumatic rupture of the aorta in adolescence--description of two cases.

Aortic disruption is a well documented cause of death in motor vehicle accidents and falls from heights. These injuries also affect children. About 10 % who survive despite aortic injury could potentially be saved provided the diagnosis is established and surgical intervention is undertaken early enough. We present here 2 cases of adolescents aged 17 years, treated in our hospitals with different results. In the first case, timely diagnosis of aortic pseudoaneurysm could not be made, which resulted in its rupture and the death of the patient. In the other patient an early diagnosis of aortic injury was established already in the Emergency Department. The patient was then transferred for further surgical treatment which proved successful. Diagnosis of traumatic aortic rupture is impossible at the accident site and can also be missed in hospital. The symptoms of aortic rupture are not characteristic. The knowledge of the mechanism of injury is extremely important. The diagnosis is established based on chest X-ray, computed tomography, and transoesophageal echocardiography. In cases of doubt, aortography remains decisive in the identification of an aortic injury.     

Traumatic aneurysm of the ascending aorta in a child

A case of traumatic aneurysm of the ascending aorta in a child is reported. This complication must be suspected in a child who sustains severe injury from closed thoracic trauma and develops an abnormally wide anterior mediastinum. A mechanism for ascending aortic rupture and aneurysm is proposed. Aortography is essential when aortic injury and its complications are suspected.     

Traumatic diaphragmatic rupture in a pediatric patient: a case report

Diaphragmatic rupture following blunt abdominal trauma is an uncommon life-threatening injury in children. In addition to its high mortality rate, there is a significant amount of morbidity associated with this injury. Emergency medicine physicians must maintain a high index of suspicion for diaphragmatic rupture and its associated complications when evaluating victims of blunt abdominal trauma.     

Tracheobronchial rupture in a child following blunt trauma

A 6-year-old boy sustained a crush injury to the upper chest that resulted in a linear laceration of the membranous part of the lower trachea and right main stem bronchus. He presented with extensive subcutaneous emphysema, pneumomediastinum, and pneumoperitoneum. The diagnosis was indicated by a CT scan of the chest and confirmed by bronchoscopy. The trachea was intubated in the operating room after rigid bronchoscopy. Intraoperative leakage of gas from the tracheobronchial laceration was minimized by single left-lung manual ventilation and application of moist packs to the site of tracheal injury. Surgical repair was achieved with interrupted sutures of non-absorbable material; a pedicle pleural flap was used to buttress the suture line. The patient was discharged in good condition after 1 week. Complete healing of the anastomosis was attested at bronchoscopy 2 months postoperatively. The rarity of tracheobronchial lacerations in childhood is noted on review of the literature. Emphasis is placed on early recognition and expeditious management of tracheobronchial lacerations. Rarely, these lacerations have been reported to heal spontaneously.     

Traumatic abdominal aortic dissection in a 16-month-old child

Abdominal aortic injury after blunt trauma is rare in the pediatric population. There have been fewer than 20 reported cases in the literature since 1960, and most were the result of motor vehicle collisions. We report the case of a 16-month-old boy who is the youngest reported patient to sustain this type of injury. We discuss the radiologic findings in multiple imaging modalities, mechanisms, associated injuries and management options.     

Spontaneous arachnoid cyst rupture in a previously asymptomatic child: a case report.

Arachnoid cysts are benign congenital cavities arising in the subarachnoid space. Non-traumatic subdural effusion of cerebrospinal fluid is a rare complication requiring surgical treatment. CASE REPORT: A 15-year-old boy was admitted to the hospital because of symptoms related to acute intracranial hypertension (headache and vomiting). The cerebral CT-scan revealed a subdural hygroma adjoining a voluminous Sylvian arachnoid cyst. Two arachnoid cysts were incidentally discovered 11 years before this dramatic complication. Moreover, the patient had suffered a cerebral concussion 2 years earlier, but interestingly did not develop cystic hemorrhage or rupture, contrary to numerous cases previously described in the literature. The location of the cysts and their regular follow-up did not allow foreseeing a cystic rupture. Hygroma evacuation was first performed after which a subdural peritoneal shunting, using a programmable opening pressure valve, was implanted. Spontaneous rupture into the subdural space represents an unusual complication of arachnoid cysts. Clinical aspects, radiographic findings, pathogenesis and surgical management are described. It is important to point out that subdural hygroma or haematoma should never be excluded in the absence of trauma history, even in the case of small non-progressive cysts regularly supervised.     

Traumatic rupture of a choledochal cyst masking as a duodenal hematoma

Choledochal cysts are rare, congenital malformations of the intra and/or extrahepatic biliary tree. We describe a case in which a patient was transferred to our hospital with a reported duodenal hematoma. The patient ultimately required exploration when his condition deteriorated. Laparotomy resulted in the discovery and successful treatment of a ruptured type IV-A choledochal cyst.