Presentation
Stabbing injury to chest.
Patient Data
There is no pneumothorax or hemothorax and both lungs are clear. There is marked widening of the mediastinum. Most of this is a rather prominent aortic arch and descending thoracic aorta. However, the right paratracheal region is also widened. This is a well-centered chest x-ray and the possibility of a mediastinal vascular injury needs to be entertained.
Arterial phase contrast enhanced scans performed.
Aortic dissection with intimal flap noted in the thoracic aorta commencing just distal to the subclavian artery branch point extending down to the T10 level. The maximum transverse diameter measures 57 mm just distal to the subclavian artery branch point. No mediastinal hematoma or pericardial effusion is demonstrated.
Mild cardiomegaly. Biapical blebs. No pneumothorax demonstrated. Lingular and bibasal atelectasis. No pleural effusion. No abnormality in the anterior chest wall identified, despite the history of left mid-clavicular line stabbing. No bony injury identified. Within the limitations of the study imaged upper abdominal viscera are unremarkable.
Conclusion:
Type B aortic dissection with intimal flap seen extending to the T10 level.
Treating Doctor informed at the time of reporting.
Case Discussion
This case shows aortic dissection in a patient who had a stabbing wound. The dissection is likely completely incidental to the injury, as aortic dissection is not typically associated with trauma.
It is important to classify the extent of the dissection flap as it has management implications.
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