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Inferior thyroid artery injury due to airbag deployment
Injury, Int. J. Care Injured 33 (2002) 283– 284 www.elsevier.com/locate/injury
Case report
Inferior thyroid artery injury due to airbag deployment Christian Boldin a,*, Gerolf Peicha a, Jo¨rg Michael Passler a, Hubert Hauser b, Michael Riccabona c a
Department of Traumatology, Medical School, Uni6ersity of Graz, Auenbruggerplatz 7a, A-8036 Graz, Austria b Department of General Surgery, Medical School, Uni6ersity of Graz, Graz, Austria c Department of Radiology, Medical School, Uni6ersity of Graz, Graz, Austria Accepted 25 May 2001
1. Introduction The use of airbags has decreased the morbidity and mortality from traffic accidents when used in conjunction with lap and shoulder seat belts [1 – 4]. However, case reports of injuries due to the deployment of airbags such as corneal abrasions, facial erythema, contusions, abrasions, fractures, aortic transections, heart valve injuries and loss of hearing have also been noted [5]. We report the case of an elderly front seat passenger who sustained a rupture of the inferior thyroid artery when the airbag deployed during a front-to-sideon collision. To our knowledge, this has not been previously reported.
2. Case report
spiral CT with CT-angiography and reconstruction was performed. This revealed a large haematoma of the left neck region with suspicion of injury to the thyroid artery (Fig. 1). At the time of surgical exploration a rupture of the left inferior thyroid artery was detected and treated by direct ligature. The postoperative course was uneventful. The patient was extubated 1 day after the operation and was discharged at 10 days.
3. Discussion Arterial damage following blunt injury is uncommon and is usually the result of a high energy trauma. Arterial rupture associated with airbag deployment is rare [6,7]. Frontal airbags have been shown to enhance the protection of a belted occupant in a frontal collision
A 66-year-old male driver seated on the left of a left hand drive car was involved in a frontal-to-left side crash. He was taking anticoagulants following an aortic valve operation 12 years before At the time of collision the driver was restrained by 3 point seat belts and the front and side airbags deployed. There was no interior damage to the car. The patient reported pain in his neck and left shoulder. Because of respiratory insufficiency, he was orotracheally intubated without any problems. In the emergency room, standard radiographs revealed a fracture of the left clavicle. Because of increasing swelling of the left neck region, contrast enhanced * Corresponding author. Tel.: + 43-316-3852155; fax: +43-3163853582. E-mail address: [email protected] (C. Boldin).
Fig. 1. Contrast enhanced spiral CT shows a marked hematoma of the left neck region shifting and compressing the trachea and esophagus to the contralateral side.
0020-1383/02/$ - see front matter © 2002 Elsevier Science Ltd. All rights reserved. PII: S 0 0 2 0 - 1 3 8 3 ( 0 1 ) 0 0 0 8 0 - 8
284
C. Boldin et al. / Injury, Int. J. Care Injured 33 (2002) 283–284
by reducing head and facial injuries [8]. Airbags are inflated initially at a rate of about 60 mls/msec with inflation being completed within 50 msec after sensing a severe crash [7]. Airbag deployment occurs in two phases. The first phase represents the initial ‘punch out’ of the bag from the module. ‘Punch out’ lasts less than 10 ms and is responsible for thoracic injuries by high speed sternal force and direct contact. The second phase results from ‘membrane force’ of the rapidly inflating pressurized airbag, acting as a membrane. This force results in a high compression over a large area of the body away from the central module. In the case described here the driver was involved in a side-frontal vehicular crash. At the time of the collision the driver was restrained by three point seat belts. His head did not touch the frontal airbag but there was contact with the left side of his face and neck. He sustained a fracture of the left clavicle and a rupture of the left inferior thyroid artery—both apparently due to airbag deployment. Cardiac injuries [9– 12] and aortic injuries [6,7] caused by airbag deployment have been previously reported. Some of the injured patients had not been restrained, others had not maintained a safe distance from the steering wheel [13]. We could reconstruct this patient%s seating position only by history. He reported sitting a normal distance from the steering wheel. Because of the low position in the seat, the side airbag of his seat could not be responsible for thyroid artery rupture similary due to anatomical topography the fractured left clavicle could not have damaged the inferior thyroid artery. Thus, the ‘membrane force’ of the airbag deployment seems to be the only reason for the rupture of the inferior thyroid artery. Drivers and passengers are not always healthy individuals. They might suffer from osteoporosis leading to a higher risk of fracture, or they may be anticoagulated
in which case there is a higher risk of internal bleeding, as reported here. Airbags may change the nature and severity of injuries but patients with such a preexisting medical history would be at risk if no airbag deployment occurred.
References [1] Huelke DF, Moore JL, Ostrom M. Airbag injuries and occupant protection. J Trauma 1992;33:894. [2] Jagger J, Vernberg K, Jane JA. Airbags: Reducing the toll of brain trauma. Neurosurgery 1987;20:815. [3] National Highway Traffic Safety Administration. Airbag Deployment Characteristics. Springfield, VA: National Technical Information Service, February 1992, DOT HS, 807:869. [4] Todd KH. Airbags and the teachable moment. Ann Emerg Med 1996;28:242. [5] Brown DK, Roe EJ, Henry TE. A fatality associated with the deployment of an automobile airbag. J Trauma 1995;39(6):1204 – 6. [6] Dunn JA, Williams MG. Occult ascending aortic rupture in the presence of an airbag. Ann Thorac Surg 1996;62(2):577 –8. [7] deGuzman BJ, Morgan AS, Pharr WF. Aortic transection following airbag deployment [letter]. New Engl J Med 1997;337(8):573 – 4. [8] Lau IV, Horsch JD, Viano DC, Andrzejak DV. Mechanism of injury from air bag deployment loads. Accid Anal Prev 1993;25:29 – 45. [9] Reiland-Smith J, Weintraub RM, Selke FW. Traumatic aortic valve injury sustained despite the deployment of an automobile air bag. Chest 1993;103:1603. [10] Lancaster GI, DeFrance JH, Borruso JJ. Airbag-associated rupture of the right atrium. New Engl J Med 1993;328:358. [11] Hanna KM, Weiman DS, Pate JW, et al. Aortic valve injury secondary to blunt trauma from an air bag. Tenn Med 1997;90:195 – 6. [12] Sharma OP, Mousset XR. Review of tricuspid valve injury after airbag deployment. Presentation of a case and discussion of mechanism of injury. J Trauma 2000;48(1):152 – 6. [13] Jumbelic MI. Fatal injuries in a minor traffic collision. J Forensic Sci 1995;40:492 – 4.
Case report
Inferior thyroid artery injury due to airbag deployment Christian Boldin a,*, Gerolf Peicha a, Jo¨rg Michael Passler a, Hubert Hauser b, Michael Riccabona c a
Department of Traumatology, Medical School, Uni6ersity of Graz, Auenbruggerplatz 7a, A-8036 Graz, Austria b Department of General Surgery, Medical School, Uni6ersity of Graz, Graz, Austria c Department of Radiology, Medical School, Uni6ersity of Graz, Graz, Austria Accepted 25 May 2001
1. Introduction The use of airbags has decreased the morbidity and mortality from traffic accidents when used in conjunction with lap and shoulder seat belts [1 – 4]. However, case reports of injuries due to the deployment of airbags such as corneal abrasions, facial erythema, contusions, abrasions, fractures, aortic transections, heart valve injuries and loss of hearing have also been noted [5]. We report the case of an elderly front seat passenger who sustained a rupture of the inferior thyroid artery when the airbag deployed during a front-to-sideon collision. To our knowledge, this has not been previously reported.
2. Case report
spiral CT with CT-angiography and reconstruction was performed. This revealed a large haematoma of the left neck region with suspicion of injury to the thyroid artery (Fig. 1). At the time of surgical exploration a rupture of the left inferior thyroid artery was detected and treated by direct ligature. The postoperative course was uneventful. The patient was extubated 1 day after the operation and was discharged at 10 days.
3. Discussion Arterial damage following blunt injury is uncommon and is usually the result of a high energy trauma. Arterial rupture associated with airbag deployment is rare [6,7]. Frontal airbags have been shown to enhance the protection of a belted occupant in a frontal collision
A 66-year-old male driver seated on the left of a left hand drive car was involved in a frontal-to-left side crash. He was taking anticoagulants following an aortic valve operation 12 years before At the time of collision the driver was restrained by 3 point seat belts and the front and side airbags deployed. There was no interior damage to the car. The patient reported pain in his neck and left shoulder. Because of respiratory insufficiency, he was orotracheally intubated without any problems. In the emergency room, standard radiographs revealed a fracture of the left clavicle. Because of increasing swelling of the left neck region, contrast enhanced * Corresponding author. Tel.: + 43-316-3852155; fax: +43-3163853582. E-mail address: [email protected] (C. Boldin).
Fig. 1. Contrast enhanced spiral CT shows a marked hematoma of the left neck region shifting and compressing the trachea and esophagus to the contralateral side.
0020-1383/02/$ - see front matter © 2002 Elsevier Science Ltd. All rights reserved. PII: S 0 0 2 0 - 1 3 8 3 ( 0 1 ) 0 0 0 8 0 - 8
284
C. Boldin et al. / Injury, Int. J. Care Injured 33 (2002) 283–284
by reducing head and facial injuries [8]. Airbags are inflated initially at a rate of about 60 mls/msec with inflation being completed within 50 msec after sensing a severe crash [7]. Airbag deployment occurs in two phases. The first phase represents the initial ‘punch out’ of the bag from the module. ‘Punch out’ lasts less than 10 ms and is responsible for thoracic injuries by high speed sternal force and direct contact. The second phase results from ‘membrane force’ of the rapidly inflating pressurized airbag, acting as a membrane. This force results in a high compression over a large area of the body away from the central module. In the case described here the driver was involved in a side-frontal vehicular crash. At the time of the collision the driver was restrained by three point seat belts. His head did not touch the frontal airbag but there was contact with the left side of his face and neck. He sustained a fracture of the left clavicle and a rupture of the left inferior thyroid artery—both apparently due to airbag deployment. Cardiac injuries [9– 12] and aortic injuries [6,7] caused by airbag deployment have been previously reported. Some of the injured patients had not been restrained, others had not maintained a safe distance from the steering wheel [13]. We could reconstruct this patient%s seating position only by history. He reported sitting a normal distance from the steering wheel. Because of the low position in the seat, the side airbag of his seat could not be responsible for thyroid artery rupture similary due to anatomical topography the fractured left clavicle could not have damaged the inferior thyroid artery. Thus, the ‘membrane force’ of the airbag deployment seems to be the only reason for the rupture of the inferior thyroid artery. Drivers and passengers are not always healthy individuals. They might suffer from osteoporosis leading to a higher risk of fracture, or they may be anticoagulated
in which case there is a higher risk of internal bleeding, as reported here. Airbags may change the nature and severity of injuries but patients with such a preexisting medical history would be at risk if no airbag deployment occurred.
References [1] Huelke DF, Moore JL, Ostrom M. Airbag injuries and occupant protection. J Trauma 1992;33:894. [2] Jagger J, Vernberg K, Jane JA. Airbags: Reducing the toll of brain trauma. Neurosurgery 1987;20:815. [3] National Highway Traffic Safety Administration. Airbag Deployment Characteristics. Springfield, VA: National Technical Information Service, February 1992, DOT HS, 807:869. [4] Todd KH. Airbags and the teachable moment. Ann Emerg Med 1996;28:242. [5] Brown DK, Roe EJ, Henry TE. A fatality associated with the deployment of an automobile airbag. J Trauma 1995;39(6):1204 – 6. [6] Dunn JA, Williams MG. Occult ascending aortic rupture in the presence of an airbag. Ann Thorac Surg 1996;62(2):577 –8. [7] deGuzman BJ, Morgan AS, Pharr WF. Aortic transection following airbag deployment [letter]. New Engl J Med 1997;337(8):573 – 4. [8] Lau IV, Horsch JD, Viano DC, Andrzejak DV. Mechanism of injury from air bag deployment loads. Accid Anal Prev 1993;25:29 – 45. [9] Reiland-Smith J, Weintraub RM, Selke FW. Traumatic aortic valve injury sustained despite the deployment of an automobile air bag. Chest 1993;103:1603. [10] Lancaster GI, DeFrance JH, Borruso JJ. Airbag-associated rupture of the right atrium. New Engl J Med 1993;328:358. [11] Hanna KM, Weiman DS, Pate JW, et al. Aortic valve injury secondary to blunt trauma from an air bag. Tenn Med 1997;90:195 – 6. [12] Sharma OP, Mousset XR. Review of tricuspid valve injury after airbag deployment. Presentation of a case and discussion of mechanism of injury. J Trauma 2000;48(1):152 – 6. [13] Jumbelic MI. Fatal injuries in a minor traffic collision. J Forensic Sci 1995;40:492 – 4.