Cardiac and Vascular Injuries

• Direct cardiac trauma were described in children aged nine weeks to five years ^1-5
• Half of the children died as a consequence of their injury ^1-3
• Injuries included traumatic ventriculoseptal defects ^1,4,5, laceration and intimal tears of the right atrium ^2,3, transmural laceration of the apex of the left ventricle ¹ and traumatic right ventricular aneurysm ⁵
• Co-existent injuries included abdominal injuries, fractures, and head injury

•  A single case described intra-cardiac needle insertion by the parent ¹

• Vascular injuries included two injuries to the abdominal aorta ^1,2
• One occurred as a consequence of a kick to the abdomen, resulting in a large pseudo-aneurysm presenting four months after the assault ²
• The second case was a fatal acute traumatic transection of the abdominal aorta in association with complete fracture-dislocation of the lumbar spine. This case was thought to be due to a hyperextension injury to the spine ¹

 Pulmonary Trauma

• Children aged three weeks to 18 months have been described with pulmonary contusions or subpleural contusions ^1-5
• Co-existent injuries included multiple rib fractures, head injury, bruising and abdominal injuries ^1-5
• The children presented with respiratory difficulty or collapse and pneumothorax in one case ¹

• One case recorded needle insertion into the neck, mediastinum, and left forearm. The mediastinal needle lay close to the great vessels ¹

Pharyngeal and Oesophageal Trauma

(Pharyngeal injuries are also addressed in our Oral Injuries review)

• Pharyngeal and oesophageal trauma were predominantly addressed in 10 studies ^1-10
• Injuries to the posterioir pharynx  included tear, and occasionally complication by retropharyngeal pouch or abscess formation ^2-4,6-8,10
• The children presented with subcutaneous emphysema, oral bleeding or drooling, respiratory distress or difficulty swallowing ^2-4,6-8,10

• Injuries to the oesophagus included laceration and perforation ^1,5,9
• These children were aged 0-9 months and all presented with irritability, poor feeding, respiratory distress or increasing swelling of the neck and chest with subcutaneous emphysema ^1,5,9

 Chylothorax

•  Trauma to the thoracic duct leading to chylothorax is recorded in children aged 6-18 months ^1-4
• Children presented with increasing respiratory distress ^1-4
• All children had co-existent rib fractures, and other fractures ^1-4
• In addition bruising, subdural haematoma and corneal abrasions were noted in one case ¹