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Pneumomediastinum and pneumothorax from blunt cervical trauma in children
S R Schoem1, S S Choi, G H Zalzal
1Children's National Medical Center, Washington, DC 20010, USA.
Insights
Even minor neck injuries in children can cause serious tracheal tears, leading to pneumomediastinum. Management varies from conservative care to emergency tracheotomy and tube thoracostomy based on injury severity.
Area of Science:
- Pediatric Traumatology
- Thoracic Surgery
- Emergency Medicine
Background:
- Blunt cervical injuries in children are common but rarely cause severe outcomes.
- Posterior tracheal wall lacerations can occur from seemingly minor impacts.
- These injuries may result in pneumomediastinum, with or without pneumothorax.
Observation:
- Three pediatric cases illustrate a mismatch between injury mechanism and clinical presentation/management.
- The severity of initial symptoms did not always correlate with the injury's extent.
- Management strategies were dictated by the resulting respiratory compromise.
Findings:
- Pneumomediastinum without pneumothorax can often be managed conservatively.
- Massive pneumomediastinum with pneumothorax frequently requires immediate tracheotomy and tube thoracostomy.
- Early recognition of potential tracheal injury is crucial.
Implications:
- Highlights the importance of thorough evaluation for pediatric neck trauma, regardless of apparent severity.
- Informs emergency management protocols for pediatric airway and thoracic injuries.
- Emphasizes the need for prompt surgical intervention in severe cases to prevent life-threatening complications.
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.