0.25 Images of memorable cases: case 25

25. traumatic asphyxia

This condition results from a severe compressive or squeezing injury to the upper abdomen or thorax. The consequent sudden rise inintrathoracic pressure forces a large volume of blood cephalad, causing distention of capillaries and venules in the head and neck. This rapid-firesequence of events leaves the victim with a never-to-be-forgotten, pathognomonic appearance—striking bluish-red to bluish-black discoloration of the face, neck,and upper part of the thorax (image 1), along with massive subconjunctival hemorrhages. Commonly, these hemorrhages cover only the interpalpebral areaswhere there is little counterpressure from adjacent tissues (image 2). About 90% of victims who survive for an hour or more will recover, usually completely. There is no differential diagnosis!

The patient shown was working in his barn when a bale of hay fell from its mooring and pinned him to the ground. Aftertemporarily losing consciousness, he was able to extricate himself and call for help. He made a full recovery.