Presentation
High speed car accident.
Patient Data
Right upper zone pulmonary contusion. Widening of the superior mediastinum greater than expected for supine positioning in a young normal weight patient suspicious for mediastinal hematoma. Furthermore, the nasogastric tube appears deviated to the right in the superior mediastinum which is a sign often seen with periaortic hematoma.
There is a large mediastinal hematoma centered around the aorta. There is a traumatic pseuodoaneurysm of the aorta at the level of the aortic isthmus consistent with contained aortic rupture. Airspace opacity is seen posteriorly within the right upper lobe and within the posterior portions of both lower lobes most consistent with pulmonary contusion. Within the apical segment of the right lower lobe two small traumatic pneumatoceles are identifed. No fractures.
Case Discussion
Traumatic pseudoaneurysm of the aorta (contained aortic rupture) with large periaortic mediastinal hematoma, pulmonary contusions and two small traumatic pneumatoceles.
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