Traumatic aortic transection

Case contributed by Dr Abdallah Mohamed

Presentation

Motor vehicle collision with multiple fractures, signs of chest trauma, and hemodynamic instability

Patient Data

Age: 50 years
Gender: Male
X-ray

CT scanogram from a trauma CT series shows a widen superior mediastinum, mild tracheal deviation to the right, decreased left lung volume with increased attenuation, left-sided pleural effusion with apical pleural capping.

Multiple fractures involving left clavicle, ribs as well as pelvic bones fractures.

CT

There is an abnormal proximal descending aortic contour, approximately 2.5 cm from the left subclavian origin, with the formation of a small pseudoaneurysm anteriorly, an intraluminal linear filling defect consistent with intimal flap. There is a large periaortic and mediastinal soft tissue stranding suggestive of a mediastinal hematoma. Few linear densities noted intimately related to the anterior contour bulge/pseudoaneurysm but there was no change in size or density of the periaortic hematoma to be convincing for active extravasation, this probably represents a side branch. Features are consistent with traumatic aortic transection with the formation of a small pseudoaneurysm.

Dense left-sided pleural fluid and apical pleural density consistent with hemothorax with associated left lower lobe collapse. A chest tube noted posteriorly within the left hemithorax with associated soft tissue emphysema. Multiple fractures of the left ribs and clavicle.

A note made of Bovine aortic arch and anomalous left vertebral artery origin from the aortic arch. ETT in a good position. 

Annotated image

The case nicely presents some of the common findings in traumatic aortic injury.

The CT scanogram (1st image) and the coronal reformatted image (2nd image) show typical features like widening mediastinum (blue arrows), tracheal deviation (red arrow), depressed LT main stem bronchus (white arrow), and LT apical pleural capping (black arrowheads)

Saggital reformated MIP image shows the intimal flaps, the abnormal contour, and pseudoaneurysm (Turquoise arrows)

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Case information

rID: 82857
Published: 7th Oct 2020
Last edited: 7th Oct 2020
Inclusion in quiz mode: Included