MVA vs. tree. Driver. Haemodynamically stable.
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A step with relative bulge is seen at the isthmus of the thoracic aorta just distal to the visible ligamentum arteriosum. No definite intimal flap or mural haematoma is identified. Soft tissue density is seen in the anterior mediastinum, this is suspicious for mediastinal haematoma. Pulmonary contusions are seen in the right middle and lower lobe. Small right sided pleural fluid collection, which is most likely haemothorax. No pneumothorax identified. Displaced right mid-clavicular fracture and posterior 4th rib fracture and non-displaced right lateral 5th rib fracture.
The appearance of the thoracic aorta is felt most likely to represent a ductus diverticulum although there are mildly atypical features, including its inferolateral projection and possible lack of contiguity with the ligamentum arteriosum mean that TAI is not entirely excluded, although unlikely. therefore, follow-up imaging in 24-48 hours and, if unchanged, in 3-4 weeks is recommended.
The patient went on to receive follow-up imaging and no traumatic aortic injury was identified, confirming this as a ductus diverticulum.