Chest multitrauma - aortic injury

Case contributed by Dr Craig Hacking

Presentation

High speed MVA.

Patient Data

Age: 40 years
Gender: Male

CT angiogram thorax

Periaortic haematoma extending from the mid arch down to the level of the diaphragm. This is not associated with a focal intimal flap, however there is slight irregularity to the undersurface of the arch in the region of the ductus arteriosus.

Moderate right and small left haemopneumothoraces. Intercostal catheters in situ bibasally. Bilateral subcutaneous emphysema.

Multifocal pulmonary contusion throughout the periphery of the right lung and in the left apex and posterior lung.

Minimally displaced oblique fracture through the lower body of sternum.

Dislocated right sternoclavicular joint and mildly displaced fractures through the right first to sixth costal cartilages.

Right 5th and sixth comminuted head and neck of rib fracture. Right ninth angle of rib fracture.

Left first neck and lateral rib fractures. Second to fourth posterolateral rib fractures. Comminuted left fifth to twelfth neck of rib fractures.

CT abdomen/pelvis

No haemoperitoneum. No injury to solid or hollow abdominal viscera is identified. No pelvic fracture.

Thoracolumbar spine

At T5-T6 level there is a complex 3 column fracture dislocation characterised by:

an oblique fracture traversing from left T5 vertebral body across disc into right lateral T5 vertebral body

fractures through the T5 right pars intra-articularis and left pedicle/pars interarticularis, which then traverse the laminae and base of spinous process

Fractures through the bilateral T6 pedicles and the T6 spinous process

There is approximately 1 cm lateral translocation across the T5/6 level. The spinal canal at this level is almost obliterated by multiple displaced fracture fragments.

Left T5-T9 transverse process fractures. Left L1 and L2 transverse process fractures

T10, T11 and T12 vertebral bodies contain minimally displaced fractures through the right superior lateral corners.

Conclusion

  1. Periaortic haematoma is highly suspicious for traumatic aortic injury in this context. No intimal flap, however there is mild irregularity to the undersurface of the arch adjacent to ductus arteriosus, which is suspected to be the site of injury.
  2. Extensive injury to the bony thoracic cage including sternal, multiple bilateral rib fractures, multiple right costal cartilage fractures, dislocated right sternoclavicular joint.
  3. Bilateral haemopneumothoraces and pulmonary contusion, worse on the right.
  4. T5-6 comminuted fracture dislocation with obliteration of the bony spinal canal.
  5. T10-T12 minimally displaced vertebral body fractures.
  6. Left T5-L2 transverse process fractures.
PlayAdd to Share

Case information

rID: 34708
Case created: 5th Mar 2015
Last edited: 23rd Sep 2017
Systems: Vascular, Chest, Trauma
Tag: trauma
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.