Presentation
Pedestrian vs. motorbike. GCS 8 at scene. Limb injuries.
Patient Data
Normal cardiac size. Left perihilar airspace opacity, silhouetting the inferior hilum, likely representing contusion in this context. Multiple left rib fractures. Minor left basal atelectasis. The ETT appears well positioned.
Traumatic aortic injury is evident with a contained rupture on the undersurface of the aortic arch, at the attachment of the ligamentum arteriosum.
Fractured left second through eighth ribs. The upper fractures are segmental and there is displacement of the third rib into the lung. Adjacent pulmonary contusion and atelectasis. Mild right lung atelectasis. Moderate sized left pneumothorax.
Patient proceeded to angiography for a endovascular thoracic aortic stent graft repair performed by the vascular surgeons.
Heart size is within normal limits. Lungs and pleural spaces are normal. Right internal jugular vascular sheath; central venous catheter tip lies in the SVC. Thoracic aortic stent-graft noted.
Case Discussion
In any trauma it is important to view the thoracic aorta in multiple planes because this injury is difficult to see in axial plane but is much more obvious in coronal and sagittal planes.
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