Aortic transection

Case contributed by Dr Sophie O'Dowd

Presentation

Road traffic collision (car vs motorcycle) from a speed of 60 mph. Motorcyclist was thrown 30 meters away. Red trauma call. GCS 15. Episode of hypotension. Ischaemic right leg.

Patient Data

Age: 21
Gender: Male
CT

There is a dissection flap which arises at the distal aortic arch with perfusion of false and true lumens. Immediately distal to this a further linear transmural density with intra-mural haematoma is seen and is consistent with a contained aortic transection. There is also a mediastinal haematoma. 

There is a moderate sized haematoma in the right pelvis and a filling defect in the right external iliac artery proximally in keeping with vessel injury, probably from traumatic dissection. The femoral artery is perfused distally. The stomach is fluid filled and distended placing the patient at risk of aspiration.

 

DSA (angiography)

DSA images demonstrate extravasation of contrast and irregularity at the point of aortic transection and dissection along with endovascular thoracic aortic stent graft insertion.

Case Discussion

Contained descending thoracic aortic rupture and dissection - managed with endovascular stent insertion.

Right external iliac artery thrombus probably from traumatic dissection and a large right pelvic haematoma - managed conservatively.

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Case information

rID: 47799
Case created: 3rd Sep 2016
Last edited: 18th Oct 2016
Inclusion in quiz mode: Included

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