Fluorescein angiographic findings in a case of traumatic asphyxia.

Traumatic asphyxia (compression cyano­ sis) is a syndrome characterized by blue dis­ coloration of the face, neck, and upper chest.' It is the result of severe compression of the thorax. This injury is not uncommon ; about 200 cases have been reported. Most cases have been due to mechanical compres­ sion, but reports have included etiologies as diverse as trampling in riots, unsuccessful attempts at suicide by hanging, epileptic sei­ zures, vomiting, pertussis, deep sea diving, explosions, and difficult obstetrical deliveries with either the mother or child involved. Following the injury, an intense blue color (ecchymotic mask) covers the face, neck, and upper chest down to about the third rib anteriorly and over the trapezius muscles posteriorly. If a tight hat, collar, or suspen­ ders are worn, the constricted areas do not turn blue. Skin biopsies have shown that the blood is usually contained within dilated cap­ illaries. The blue color is probably due to deoxygenated blood present in the dilated capillaries. The blue color blanches under pressure, and characteristically disappears within a week without undergoing the chro­ matic changes of a hemorrhage. Survival and prognosis are directly related to associ­ ated defects which include fractures of cer­ vical and thoracic bones, but not the skull, and contusion or rupture of thoracic and ab­ dominal viscera. Loss of consciousness is common and disorientation and cerebral irri­ tation have been noted. Hemorrhages are rarely found within the brain due to its sup­ port by the skull.