Aortic arch traumatic pseudoaneurysm

Case contributed by Chris Newman
Diagnosis almost certain


Scooter driver versus car.

Patient Data

Age: 20 years
Gender: Male
  • widening of the superior mediastinal outline to the left of the trachea with poor definition of the aortic knuckle and displacement of the left paraspinal line is suspicious for mediastinal / aortic injury
  • focal saccular out-pouching of the aortic arch located superior to the isthmus 
  • the saccular out-pouching is oriented medially and difficult to appreciate on other planes aside from the axial series
  • small mural hematoma extending along the upper aspect of the descending thoracic aorta
  • aberrant right subclavian artery with retro-esophageal course noted
  • no dissection flap

Case Discussion

Acute traumatic aortic injury with small saccular pseudoaneurysm involving the aortic arch superior to the isthmus.

The location and morphology of this injury is unusual and may be associated with the aberrant retro-esophageal right subclavian artery, which may have altered the shearing forces / points of fixation within the mediastinum.

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