Minimal aortic injury

Case contributed by Craig Hacking

Presentation

Motorbike accident.

Patient Data

Age: 35 years
Gender: Male
x-ray

ETT tip projects within the upper thoracic trachea. Subtle hazy air space opacification within the right and  lower zones, most in keeping with aspiration but may represent early contusion. No pleural effusion or pneumothorax. No air leak. Mediastinal contours are normal for projection. No displaced fracture.

ct

Normal three-vessel aortic arch. Small (< 10 mm) intimal irregularities of the medial wall of the descending thoracic aorta just distal to the isthmus. No periaortic hematoma.

No heart and pericardium are unremarkable. Small amount of prevertebral hematoma at the cervicothoracic junction. Small retrosternal hematoma 10 mm in maximal thickness to the left of the anterior mediastinum.

Patchy air space opacification represents contusion. Bilateral dependent change within the posterior lungs. No pleural effusion or pneumothorax. Tracheobronchial tree is patent.

Left anterior 6th and 7th rib fractures, and the posterior 2nd rib. Minimally displaced fracture in the inferior sternal body.

Anterior vertebral body fracture of the superior endplate of T1.

IMPRESSION

Medial proximal descending thoracic aorta minimal intimal injury.

Pulmonary contusions.

Sternal and left rib fractures. No flail segment.

Anterior vertebral body fracture T1 (single column).

dsa

Aortogram shows minor medial wall intimal irregularity of the upper descending aorta. No extravasation or dissection demonstrated.

Aortic stent deployed successfully.

Case Discussion

This case illustrates the typical location and appearance of minimal aortic injury.

The patient recovered uneventfully following aortic stenting.

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