Traumatic aortic injury

Case contributed by Dr Andrew Dixon

Presentation

Car accident.

Patient Data

Age: 75
Gender: Male

This case featured in our 2016 Trauma Radiology Course which is now available to view online.

X-ray

Angulation of the right 7th, 8th and 9th ribs anterolaterally suggestive of fracture. No other definite evidence of traumatic injury. The apparent widening of the superior mediastinum is not an unexpected finding in a supine patient of this age and in itself is not necessarily indicative of trauma. The fact that the majority of the superior mediastinal widening is to the left of the trachea (trachea slightly pushed to right) is potentially a more sinister finding, but this is still not an overly reliable sign of aortic injury.  

CT

CT Chest

Acute traumatic aortic injury with intimal flap at the aortic isthmus and periaortic haematoma without active bleeding seen. Incomplete fractures of the right 4th to 8th ribs are seen anterolaterally. 

Case Discussion

Acute traumatic aortic injury with intimal flap at the aortic isthmus and periaortic haematoma without active bleeding seen. Incomplete right rib fractures anterolaterally.

This case emphasises the insensitivity of chest radiographs in identifying aortic injuries, particularly in supine elderly patients where superior mediastinal widening is a common normal finding. Instead of looking for widening (which is almost always present), looking for asymmetric widening of tissue to the left of the trachea compared to the right should alert you to the possibility of an aortic injury.  

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Case information

rID: 31510
Case created: 14th Oct 2014
Last edited: 28th Jul 2016
System: Chest
Inclusion in quiz mode: Included

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