U Yetkin, S Bayrak, G ?lhan, M Bademci, T Gökto?an, M Kestelli, C Özbek, A Gürbüz
U Yetkin, S Bayrak, G ?lhan, M Bademci, T Gökto?an, M Kestelli, C Özbek, A Gürbüz. Perthes Syndrome In A Compressive Politrauma Case. The Internet Journal of Thoracic and Cardiovascular Surgery. 2007 Volume 12 Number 2.
A 31 years old patient admitted to emergency service because of a tractor accident(Figure 1).
He referred to our clinic for further investigation of suspicious flap image of ascendent aorta seen in emergent suboptimal echo.Symptomatic treatment was began because of bilateral erythemas and pethecias at conjunctiva,head and neck.There wasn't a dissection flap in thoraco-abdominal CT and TTE.There was a persistent V.C.S.(Figure 2).
Out patient clinic control was recommended for bilateral subconjunctival hemorrhagy.Orthopedic consultation showed left iliac wing fracture and 3 weeks rest was recommended(Figures 3 and 4).
Other consultation results were normal and he was discharged with symptomatyc treatment.
Thorax traumas have a wide spectrum from simple cot fractures to major injuries.Thorax effection rate is 25% in major traumas. Perthes' syndrome(Traumatic asphyxia is a rare syndrome, first described over 150 years ago by Olivier(1,2). This syndrome appears after severe and transient compressive blunt chest injury. A Valsalva maneuver is necessary before thoracic compression for the development of this syndrome(3).It is a condition characterised by subconjunctival hemorrhage, cervicofacial petechiae and cyanosis caused by severe compression of the chest(4).
It is vital for the physician to recognize the pathophysiology of the injury pattern and to remain cognizant of the high likelihood of potentially lethal associated injuries(5). Cases of traumatic asphyxia are mainly a consequence of motor vehicle crashes. Other causes include heavy machines, furniture and, rarely, deep-sea diving, epileptic seizures, difficult delivery and asthmatic attack(1,2). The duration and the weight of compression affect the outcome following traumatic asphyxia(1).
Diagnosis is made by history and clinical examination. Associated injuries such as intrathoracic or abdominal lesions can be life-threatening and must be strictly assessed(4).
The facial changes can mimic those seen with massive closed head injury; however, cerebral injury after traumatic asphyxia usually occurs due to cerebral hypoxia(6). The infrequency of cerebral hemorrhage is explained by the support given to the blood vesels of the brain and meninges by the intracranial pressure, analogous to the support of the retinal vessels by the intra-ocular pressure(1). The vision can be affected by the increase in capillary pressure; for example, retinal hemorrhage has been associated with severe chest compression (Purtscher's retinopathy)(1,7).
The prognosis is good but a prolonged thoracic compression could lead to cerebral anoxia and neurological sequelae(3). Aggressive and directed management of the cardiopulmonary systems coupled with prompt recognition and treatment of associated injuries is essential for optimal patient outcome(5). Prompt treatment with attention to the reestablishment of oxygenation and perfusion may result in good outcomes(6).