Olivier Syndrome: Traumatic Asphyxia

A 51 year-old woman was found confused while crawling across a field. She had marked facial cyanosis and edema with cutaneous petechiae, subconjuctival hemorrhages, and echymosis across her anterior neck (image 1). Mild cerebral edema and a non-displaced thyroid cartilage fracture were found on computed tomography (CT) . The patient recovered full neuro-cognitive function within 24 hours and reported that she had been assaulted and choked by the throat. Her airway remained stable and the laryngeal injury was treated conservatively; she was discharged home after three days. Olivier described this syndrome over 150 years ago after thoraco-abdominal crush injuries. It is essentially a prolonged valsalva maneuver that results in increased venous pressure and stasis above the level of the compressive force.1,2 The consequent findings on the chest, neck and face are startling but of no prognostic significance, and the majority of patients have a favorable outcome.2,3