What is the most common site of Traumatic aortic injury?
The aortic isthmus is the most susceptible area to injury as this is the junction of the relatively mobile proximal thoracic aorta and the fixed distal aortic arch at the insertion of the ligamentum arteriosum.
By what mechanisms can the bowel be injured in blunt trauma?
1. Crush injury, where the bowel is compressed between the anterior abdominal wall and the spine. 2. Shearing injury, which occurs when a fixed structure is pulled away from its point of fixation, such as at the ligament of Treitz. 3. Burst injury, when there is a sudden increase in intraluminal pressure.
Chest
- blunt traumatic thoracic aortic transection and pseudoaneurysm with an associated large volume mediastinal haematoma
- displaced right posterior 12th rib fracture
- left diaphragmatic rupture with stomach herniation into the chest
- left haemothorax and pulmonary contusions
- small right sided pneumothorax and posterior pulmonary contusions
Abdomen/Pelvis
- haemoperitoneum
- small bowel mesenteric fat stranding suspicious for a mesenteric tear (high suspicion) +/- terminal ileal injury/perforation
- fat stranding in the retroperitoneum around the left renal vascular pedicle. No evidence of active bleeding or direct vascular injury. Enhancement of the left kidney is normal.
- small subcapsular splenic haematoma (AAST Grade II)
- focal right lower renal pole poorly defined cortical hypodensity, possibly a blunt renal contusion (AAST Grade I)
- low volume IVC consistent with volume depletion
- gas with the left abdominal wall and pelvis