• Trauma

A 2-year-old child presented to the emergency department after a car accident while crossing the street. He had normal primary trauma survey on arrival. On secondary survey besides scattered abrasions especially on his back and small laceration on pinna, there were several petechial haemorrhages of the face and the subconjunctival tissue with purple facial discolouration (figure 1). While awake on arrival, there was a history of few seconds of loss of consciousness after strangulation by twisted clothing collar which pinned him against the wheel and bumper. The parents cut the collar in order to release the unconscious child. No abnormality was found on his laboratory and imaging studies including brain CT. The patient's syncope was likely precipitated by compression of bilateral carotid and vertebral arteries. The rashes are due to transmission of pressure to the head via valveless superior vena cava, causing rupture of venules and capillaries. This condition happens when neck arteries remain open but venous pressure rises in response to ligature tightening. The presence of petechiae speaks for a probable minimum period of 10 s of uninterrupted venous compression.1 The patient was discharged after several hours of observation in the emergency department. On his follow up, after few days, all of the manifestations resolved without complications.

• Download figure
• Open in new tab
• Download powerpoint

Figure 1

Facial petechia and subconjunctival haemorrhages with purple discolouration in the face.