Blunt Chest Trauma-Related Cardiovascular Intervention in Two Pediatric Cases. A Silent Threat

Abstract

Blunt thoracic traumas due to traffic accidents or falls from a height may conceal the degree of the underlying injury, leading to an underestimation of the actual clinical picture. Two pediatric poly-traumatized patients were admitted to the emergency room following traffic accidents. The first patient was overrun by a motor vehicle and seemed to be doing well in ICU when, all of a sudden, he developed heart failure with hemodynamic instability on day 14. Transesophageal and color flow Doppler echocardiography demonstrated an acquired 10 mm ventricular septal defect with left-to-right shunting into the right pulmonary artery. The second case demonstrated a right-side pneumothorax, a left-side hemothorax, and hemomediastinum, accompanying spleen, liver, kidney, and extremity injuries following a motorcycle accident. Computed tomography scan of the thorax further revealed an image suggesting thoracic aortic transection. The initial case underwent a successful repair of the ventricular septal defect via open cardiac surgery. A transcatheter aortic stent graft was successfully placed in the second case. Although it is rare, in severe thoracic trauma, we must be aware of the possibility and search for the presence of a silent cardiovascular or intracardiac injury, as it may be fatal in origin requiring rapid intervention.

Clinical Impact

Conditions requiring surgical intervention due to blunt thoracic trauma are rare in children. We emphasized the need to exclude cardiac pathologies by using imaging methods even if the patient is stable during the initial evaluation in the emergency room. We aimed to raise awareness, especially for clinicians in emergency departments, about possible pathologies that may be fatal if not diagnosed.