Penetrating chest injury is even rarer. It occurs 6 times less frequently
than blunt trauma and almost exclusively during the teenage years. The most
common mechanisms for penetrating injury are gunshot wounds. Penetrating
thoracic trauma usually occurs in isolation and is less frequently associated
with other injuries.
When dealing with a pediatric trauma patient, childhood thoracic injury
should be considered separately from adult chest trauma. In general, thoracic
injury patterns are different in children due to anatomic and physiologic
differences between children and adults. The pediatric chest wall has increased
compliance and ligamentous flexibility, and the mediastinum is more mobile.
Ribs and skeletal structures tend to deform and bend, rather than fracture, even
when significant compressive force is applied. This pliability allows the transfer
of energy to underlying soft-tissues and organs, and may result in intra-thoracic
injury without obvious outward signs of damage. In addition, mediastinal blunt
injury is less likely in children due to the increased mobility of the mediastinal
structures. This increases, however, susceptibility to tension physiology
secondary to mechanical displacement of the trachea, superior vena cava, and
heart. Thus, pediatric chest trauma should be approached with diligent
evaluation and with a high degree of suspicion for life-threatening injuries, even
in the absence of substantial physical exam findings.
II. EVALUATION