Traumatic aortic transection

Case contributed by Andrew Murphy

Presentation

Haemodynamically unstable, post trauma.

Patient Data

Age: 30 years
Gender: Male

Inital imaging

x_ray

In keeping with the diagnostic limitations of a supine chest projection the cardiomediastinal contours are within normal limits.  The lungs and pleural spaces are clear.  No displaced rib fracture. Incorrect side marker noted. 

CT

ct

Thoracic aortic transection is seen at the aortic isthmus.  This originates approximately 5 mm distal to the origin of the left subclavian artery and extends approximately 3 cm along the length of the descending aorta.  The contour abnormality of the aorta is seen predominantly posteriorly, but also extends into the lateral and anterior walls of the aorta.  Soft tissue stranding of the mediastinum centered around the aortic isthmus suggestive of a mediastinal hematoma secondary to associated rupture.  No active contrast extravasation identified.  No hemopericardium.  Normal opacification of the ascending aorta and branches of the aortic arch.

Small high density left pleural effusion, likely a hemothorax in the clinical context.  Tiny locules of extrapleural gas seen bilaterally consistent with a tiny bilateral pneumothoraces.  The lungs and pleural spaces are otherwise clear.

Multiple left-sided rib fractures (5-8), without evidence of a flail segment.  No other fractures or dislocations.

Thoracic endovascular aortic repair

dsa

Bilateral access via the common femoral arteries. Angiography confirms CT findings of traumatic thoracic aortic dissection. A 26mm x 134 mm stent graft is placed with the proximal end placed between the left carotid and left subclavian arteries. Left subclavian origin covered. Completion angiogram satisfactory.

Case Discussion

Traumatic transection aorta as seen in this case has a high morbidity 1-3 and is often a result of blunt chest trauma. It may have a delay in diagnosis as the typical patient will present with multiple significant injuries. Thoracic endovascular aortic repair is a new and recently widely accepted treatment 1,2.

Thanks to Dr. Bradley Wray for the diagnostic CT report and case guidance.

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