Traumatic aortic injury

Case contributed by Vincent Tatco
Diagnosis certain

Presentation

Multiple injuries secondary to fall.

Patient Data

Age: 45 years
Gender: Male
x-ray
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Info

Pulmonary vascularity is accentuated possibly due to congestion.

There is increased density in the left lower hemithorax for which atelectasis, pulmonary contusion and pleural effusion are considerations.

Heart is magnified.

Endotracheal tube, nasogastric tube and bilateral chest tubes are seen. 

ct
This study is a stack
Axial C+
arterial phase
This study is a stack
Coronal C+
arterial phase
This study is a stack
Sagittal C+
arterial phase
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There is a saccular outpouching seen originating from the medial side of the proximal descending aorta 2.3 cm distal to the left subclavian artery with approximate dimensions of 2.6 x 1.5 x 2.6 cm. Given the history of trauma, the above finding is indicative of a pseudoaneurysm.

There is minimal pericardial effusion.

Atelectatic changes are seen in both lungs.

Soft tissue emphysema at the anterolateral chest wall is demonstrated.

EVAR

dsa
This study is a stack
Oblique
Aorta
This study is a stack
Frontal
Aorta
This study is a stack
Frontal
Aorta
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Info

Thoracic endovascular aortic repair (TEVAR) showing the aortic pseudoaneurysm and deployment of stent-graft within the descending aorta.

x-ray
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Post-TEVAR chest radiograph showing the stent-graft along the descending aorta.

Follow-up CT

ct
This study is a stack
Axial C+
arterial phase
This study is a stack
Coronal C+
arterial phase
This study is a stack
Sagittal C+
arterial phase
This study is a stack
VRT C+
arterial phase
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Info

Follow-up CT scan shows resolution of the previously reported pseudoaneurysm. Stent-graft is seen in place within the descending aorta without endoleak. 

Case Discussion

This is a case of traumatic aortic injury resulting to pseudoaneurysm, which was managed by thoracic endovascular aortic repair (TEVAR).

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