Tension pneumopericardium in a multiply injured child

Abstract

Tension pneumopericardium is a rare disease that is very difficult to diagnose. A 3-year old child was run over by a minibus. Computed tomography showed bilateral pneumothorax, multiple rib fractures on both sides, and a hepatic laceration. The massive blunt thoracic trauma caused entrapped air in the pericardium, and a tension pneumoprecordium developed abruptly. We report this unique case of tension pneumopericardium in a child, and the subsequent emergency surgery and damage control measures.

Iatrogenic tracheobronchial rupture after emergency intubation

“…Preclinical, both thoracic cavities have to be drained due to a pneumothorax, which can cause a tension pneumothorax, especially after ventilation [22], and may later lead to death [14,17]. The worst-case scenario is a ruptured mediastinal pleura, due to which a none-manageable air fistula can occur, which makes a sufficient oxygenation impossible [8,16,23]. The only chance for survival is given through the insertion of multiple big lumen chest tubes [12,13] and the maximization of the breath volume [12].…”

“…A computed tomographic scan has to be performed in order to to exclude additional injuries [6,10], for example pneumothorax or a pneumo-pericardium [14,23], which can cause a life-threatening pericardial tamponade [23]. A pneumo-mediastinum [10,14] is highly suspected for a tracheal lesion.…”

“…Only in cases of bigger defects an interposition, e.g. with pericardium [23], becomes necessary. The suture row can additionally be sealed with fibrin glue [2,8,12].…”