Traumatic thoracic aortic injury

Case contributed by RMH Core Conditions

Presentation

Car vs truck at 80 km/hr

Patient Data

Age: 77
Gender: Female
X-ray

Pneumomediastinum. Lucency at the left hemithorax with slight thickening of the left costophrenic sulcus chest indicative of supine pneumothorax. Small right pneumothorax. Subcutaneous emphysema.

Aortic knuckle is ill-defined and superior cardiomediastinal contour appears widened, although this may be due to supine positioning.

Pseudoaneurysm of the thoracic aortic artery at the isthmus with moderate middle and posterior mediastinal hematoma.

The pseudoaneurysm sack projects superomedially from the isthmic region of the thoracic aorta with a large mural rent measuring approximately 7 mm in diameter passing obliquely from the region of the ductus arteriosus to the superomedial margin of the isthmus.

The remaining thoracic aorta is unremarkable however, marked atheroma is noted in the abdominal aorta.

Moderate right sided pneumothorax and pneumomediastinum.

Fractures of the first and second rib on the left with fractures of ribs 1-10 on the right without evidence of a flail segment.

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