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A. Haji1 M. A. Imana2
1General Surgery, South East Thames
2Accident & Emergency, Basildon and Thurrock NHS Trust, Essex
Correspondence to: A. Haji, Department of Surgery, William Harvey Hospital, Ashford, Kent, UK
We report a rare cause of traumatic petechiae without the full blown symptoms and signs of traumatic asphyxia. There were no complications encountered and there was spontaneous resolution
Keywords: Petechiae, traumatic, asphyxia Surgeon, 1 February 2005, 42
A 19-year-old boy, with no significant past medical history, presented to the Accident and Emergency department complaining of a sudden onset of a rash on his face. He noticed this after being spun around very fast on a “spinning saucer” amusement ride. At the time he felt a sudden build up of pressure in his head and face with episodes of lightheadedness. He was on no medication.
General and neurological examinations were unremarkable. Multiple petechiae in a localised butterfly pattern in the periorbital region were noted with no associated subconjunctival haemorrhage.
The patient was reassured and at a two week follow-up the petechiae had resolved spontaneously.
Traumatic petechiae is a part of a syndrome first described by Ollivier in 1837 which is characterised by cervicofacial cyanosis and oedema, subconjunctival haemorrhage, and multiple petechiae of the face, neck, and upper chest.1 It is a rare occurrence and the majority of cases are due to crush injuries to the chest and abdomen in road traffic accidents. It has also been reported in deepsea divers, unsuccessful hanging, epileptic seizures, whooping cough, violent vomiting and bronchial asthma.2 We were unable to find any reports of multiple petechiae in the literature after amusement park rides.
Although our patient did not have the full complement of clinical features described above, his multiple petechiae were prominent periorbitally. These features are thought to be attributed either directly to thoracoabdominal compression or to forceful compression of the thoracoabdominal muscles against a closed glottis. This leads to reflux of blood from the heart through the valveless great veins of the head and neck. The increased back pressure transmits to the capillaries leading to atony, dilatation and engorgement of blood and stasis. If there is no counter pressure, the blood stagnates, desaturates and gives rise to the distinct facial changes.3
In full-blown cases of traumatic asphyxia, the treatment should be directed toward the associated injuries. In our case, there were no complications and the petechiae resolved spontaneously within two weeks.
This case demonstrates an unusual cause of traumatic petechiae acquired during everyday extra-curricular activities.
Copyright 28 October 2004
1. Ollivier D. Relation medicale des evenements surveuus au Champ-de-Mars le 14 juin 1837. Ann Hyg 1837; 18 : 485-89.
2. Lowe L, Rapini RP, Johnson TM. Traumatic asphyxia. Journal of the American Academy of Dermatology 1990; 23 : 972-74.
3. Williams JS, Minken SL, Adams JT. Traumatic asphyxia : reappraised. Ann Surg 1968; 167 :384-92.