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. Ischemic right leg.
Patient Data
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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 intramural hematoma is seen and is consistent with a contained aortic transection. There is also a mediastinal hematoma.
There is a moderate-sized hematoma 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.
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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 hematoma - managed conservatively.
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