An Unusual Type of Severe Barotrauma Owing to Automobile Tire
Biting in a Child
By I. Faruk O
¨
zgu¨ ner, C¸ag˘ ri Savas¸, and Ahmet Yes¸ildag˘
Isparta, Turkey
The authors report a rare case of a barotraumatic pneumo-
thorax and pneumomediastinum associated with esopha-
geal perforation and orbital emphysema. A 4-year-old boy
presented with sudden respiratory distress after blowout of a
defective tire that he bit. Computed tomography scan
showed right pneumothorax and bilateral orbital emphy-
sema. A linear rupture has been detected in the cervical
esophagus in esophagoscopy. Stamm gastrostomy and tube
thoracostomy were performed, and broad-spectrum antibi-
otics have been introduced. Oral feeding started 23 days
after blowout of tire, and the patient was discharged 50 days
after injury.
J Pediatr Surg 39:1584-1585. © 2004 Elsevier Inc. All rights
reserved.
INDEX WORDS: Barotrauma (traumatic), automobile tire
blow out, pneumothorax, pneumomediastinum, esophageal
perforation.
A
LTHOUGH BAROTRAUMA is an important and
potentially lethal complication of mechanical ven-
tilation, there are different and extreme causative factors
such as scuba diving, air bag deployment, and inhala-
tional drug abuse.
1-4
The most widely recognized form of
barotrauma is the presence of extra-alveolar air. It in-
cludes subpleural air cysts, pulmonary interstitial emphy-
sema, pneumomediastinum, pneumopericardium, pneu-
moperitoneum, subcutaneous emphysema, and systemic
gas embolism.
5
Here, we report an unusual case of
barotraumatic pneumothorax associated with esophageal
rupture and orbital emphysema.
CASE REPORT
A 4-year-old boy with severe respiratory distress after blowout of a
defective automobile tire was seen in the emergency department. His
parents said that he bit the tire when he was playing with it. The tire
was defective; there was an aneurismatic dilatation (like a baloon) on
the tire. He bit the baloon on the tire and the tire blow out into his
mouth. The size of the tire was 165/70/13R, and its pressure was 28
kPa. On his physical examination, he was severely dyspneic, and there
was subcutaneous emphysema on the cervical and right anterior tho-
racal region. There was a right pneumothorax and pneumomediastinum
on his anteroposterior chest x-ray and thoracal computed tomography
scan (Fig 1 & 2). There was bilateral orbital emphysema on cranial
computed tomography scan (Fig 3). He was transferred immediately to
the operating theater. A chest tube was inserted into his right hemitho-
rax under general anesthesia. The surgical procedure continued with
rigid esophagoscopy. A linear rupture was detected in the cervical
From the Departments of Pediatric Surgery and Radiology, Su¨ley-
man Demirel University Medical School, Isparta, Turkey.
Address reprint requests to I. Faruk O
¨
zgu¨ner, MD, Kurtulus¸ mah,
137 cad. Eralp apt 7/9, Isparta, Turkey.
© 2004 Elsevier Inc. All rights reserved.
0022-3468/04/3910-0030$30.00/0
doi:10.1016/j.jpedsurg.2004.06.035
Fig 1. Posteroanterior chest x-ray of the patient shows right
pneumothorax.
Fig 2. Thoracic CT scan of the patient shows right pneumothorax
and subcutaneous emphysema.
1584 Journal of Pediatric Surgery, Vol 39, No 10 (October), 2004: pp 1584-1585