chapter  4
32 Pages

Inicted Fatal Thoracic and Abdominal Injuries in Infants and Young Children

ByKAREN J. GRIEST

Primary and contributing causes of fatal thoracic injuries in infants and children can be summarized as follows:

Penetrating thoracic injuries in children are rare and usually result • from fractured ribs or fractured clavicles. Blunt thoracic trauma in children is much more common than pen-• etrating injuries.2,3 Rib fractures are the most common thoracic injury in inflicted • trauma in children.1 Injury to the oral pharynx in children can result in upper airway • obstruction from aspiration of large quantities of blood or foreign objects, like teeth. Partial or complete rupture of the trachea or bronchi due to trauma • can result in rapidly increasing subcutaneous emphysema and progressive cyanosis. Major pulmonary and hilar vessels can be injured by fractured ribs • or clavicles. Multiple rib fractures can cause pneumothorax, hemopneumotho-• rax, or flail chest. Traumatic asphyxia is a result of sudden compression of the thoracic • cage. The sudden increase in pressure drives the venous blood into the capillaries, resulting in extravasations in the neck and head and hemorrhages in brain tissue with loss of consciousness, convulsions, and occasionally other significant neurologic sequelae.1 Major thoracic trauma may be associated with concomitant abdomi-• nal, cranial, or orthopedic injuries. Hypoxia and hypotension from blood loss are the immediate poten-• tially fatal sequelae of thoracic injuries in children.2,3

Fatal thoracic inflicted injuries in children are usually easily diagnosed. Abusive heart injuries, however, may be subtle and pose a diagnostic dilemma. With nonpenetrating cardiac trauma, the cardiovascular signs are often initially absent or overlooked.4