Presentation
High speed motor vehicle accident.
Patient Data
CT Angiogram Thoracic Aorta:
Arterial phase contrast enhanced scans were performed (Omnipaque 350). No previous cross-sectional imaging for comparison.
Findings:
No traumatic aortic injury or mediastinal hematoma. Note is made of a patent ductus arteriosus. The right heart and pulmonary arteries not dilated. Remnant thymic tissue noted. No enlarged hilar, mediastinal or axillary lymph nodes.
The lungs are clear with no consolidation, collapse, pulmonary nodules or masses. No pneumothorax or pleural effusions.
Multiple locules of gas and associated stranding/hematoma are in keeping with a soft tissue injury anterior to the midshaft of the left clavicle. No underlying fracture of the imaged clavicle.
No thoracic spine, rib or sternal fracture.
Conclusion:
1. No traumatic aortic injury. Narrow caliber patent ductus arteriosus without evidence of pulmonary arterial hypertension or RV hypertrophy. Cardiology review suggested.
2. Gas within the soft tissues anterior to the midshaft of the left clavicle is highly suspicious for a soft tissue laceration. No left clavicular fracture, however the clavicle has been incompletely imaged.
Case Discussion
The ductus arteriosus is a vascular channel that connects the proximal descending aorta to the roof of the main pulmonary trunk near the origin of the left pulmonary artery. It normally closes spontaneously within 24 to 48 hours after birth due to increased oxygen tension and reduced prostaglandin levels. Failure of this closure results in a patent ductus arteriosus (PDA).
PDA is uncommon in adults as it is usually identified and treated during childhood. It results in left to right shunting and clinically manifests as a continuous murmur loudest at the upper left sternal edge.
Definitive treatment is closure either via transcatheter approach or surgical ligation.
In the setting of trauma, distinction between a PDA and traumatic aortic injury is obviously crucial. In this case, the anatomical location, lack of mural irregularity, as well as the absence of mediastinal hematoma or any other significant chest injuries aids in making the diagnosis.
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