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Traumatic thoracic aortic laceration

Case contributed by Marius I. Diaconescu

Presentation

The patient was in a high speed motor vehicle collision.

Patient Data

Age: 45 years
Gender: Male

There is an incomplete tear of the medial wall of the proximal descending thoracic aorta, distal to the left subclavian artery.

It is associated with an irregularly marginated pseudoaneurysm.

There is a large prevertebral and para-aortic hematoma extending from C7 to T9.

There is a large tear in the dome of the left diaphragm with intrathoracic herniation of the gastric fundus and surrounding abdominal fat.

Incidental note is made of a left chest tube in the fissure and a right chest tube in the posterior pleural space.

There is dependent atelectasis and contusion bilterally, greater on the left.

There are multiple rib fractures bilaterally with extrapleural hematoma at both apices greater on the left.

There are also fractures of the left transverse processes of T5 to T9.   

Case Discussion

Aortic tears or lacerations are injuries in which sections of the aorta are forcibly pulled apart. Transection represents a transverse circumferential tear of the aorta. This usually results in a hematoma.  Mortality rate with these injuries is very high and patients with complete ruptures usually survive if there is containment of active bleeding by adventitia, thrombus, or mediastinal structures.

Supervised by: Dr. Geneviève Belley

Case courtesy of Dr. Joseph Cassulo

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Case information

rID: 77463
Published: 1st Jun 2020
Last edited: 22nd Sep 2020
System: Trauma, Chest
Inclusion in quiz mode: Included
Institution: McGill University

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