Thoracic aortic aneurysm rupture

Discussion:

Traumatic aortic injury is commonly seen in high-speed motor vehicle collisions1.
Chest radiographs are commonly used for screening in motor vehicle accidents. Radiographic signs of aortic injury include:

  • Mediastinal widening (greater than 8cm or 25% of the thoracic width)
  • Transverse aortic arch abnormality
  • Loss of aorto-pulmonary window

CT is considered the diagnostic test of choice for traumatic aortic injury. It has a sensitivity which is greather than 98%. Signs of aortic injury on CT include the presence of1:

  • intimal flap
  • traumatic pseudoaneurysm
  • contained rupture
  • intraluminal mural thrombus
  • abnormal aortic contour
  • sudden change in aortic caliber

Since the 1990's, there has been a shift away from open surgical repair of aortic injury. Instead, thoracic endovascular aortic repair (TEVAR) has gradually replaced open repair as the mainstay of operative aortic injury management2. It is associated with significantly lower operative times, procedural blood loss and intraoperative blood transfusion compared to open repair.

In this particular case, note the calcified walls of the aorta. Also note the bilateral hemothorax; in particular, the right sided hemithorax is full of heterogeneous fluid which is a combination of old blood and new blood from the ruptured aneurysm.

Case contributed by A/Prof. Pramit Phal.

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