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Ann Thorac Surg 1989;47:247-249
© 1989 The Society of Thoracic Surgeons

Articles

Why is the lower torso protected in traumatic asphyxia? A new hypothesis

Alan Thompson, Jr, MD, FRCS(C), Fernando F. Illescas, MD, FRCP(C), Ray C.-J. Chiu, MD, PhD, FRCS(C)*

The Montreal General Hospital and McGill University, Montreal, Quebec, Canada

Accepted for publication August 16, 1988.

* Address reprint requests to Dr Chiu, The Montreal General Hospital, 1650 Cedar Ave, Room 947, Montreal, Que, Canada H3G 1A4.

Traumatic asphyxia secondary to a crush injury of the chest is characterized by craniocervical cyanosis, subconjunctival hemorrhage, and severe vascular engorgement of the head and neck. These signs are believed to be due to high venous pressures causing stasis and capillary rupture. A "fear response" that produces a strong Valsalva maneuver is thought to be necessary for their development. The lower torso seems to be protected, and previously this was thought to be due to its superior system of valves. We present here ultrasonographic evidence that the inferior vena cava is compressed or obliterated during a Valsaiva maneuver, and propose that this compression protects the lower torso during traumatic asphyxia.




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