Aortic transection with multi-organ infarcts and bilateral popliteal artery occlusions

Case contributed by Chris Newman

Presentation

Shock trauma. Head and chest injury. Deformed leg.

Patient Data

Age: 30 years
Gender: Male
  • bilateral intercostal catheters, endotracheal tube and enteric tube. The enteric tube tip is not well seen below the diaphragm and appears malpositioned
  • opacity within the right mid to lower zone may represent a traumatic contusion or atelectasis/collapse
  • the mediastinum and aortic knuckle appear slightly ill-defined and widened within the limits of the supine examination

Chest

  • malpositioned enteric tube with tip at the gastro-esophageal junction
  • small volume bilateral pneumothoraces with bilateral ICCs in situ. Trace left hemothorax
  • trace volume pneumonediastinum
  • bilateral lower lobe collapse
  • right posterior 1st rib fracture
  • irregular filling defect within the lumen of the aorta with extensive wall thickening and para-aortic stranding located within the proximal descending thoracic aorta in keeping with an acute aortic transection

Abdomen and Pelvis

  • ill-defined perfusion abnormality / hypoattenuation within the right hepatic lobe
  • wedge-shaped peripheral hypoattenuation within both kidneys and the spleen
  • small filling defect within the IVC, just superior to the draining right renal vein
  • small volume hemoperitoneum
  • complete occlusion of both popliteal arteries, with the left occurring just above the knee crease and the right just below the knee crease
  • comminuted left mid-shaft femur fracture

Case Discussion

Aortic transections are life threatening injuries. This case outlines diffuse embolic sequelae associated within the abdomen and both limbs.

The small filling defect within the IVC was through to be venous thrombus / fat embolism from the left femur long bone fracture - it is always important to check both the venous system and the pulmonary arteries for emboli in the setting of long bone fractures. 

This patient survived and went onto having urgent endo-luminal thoracic aortic graft and bilateral popliteal thrombectomies. 

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