Traumatic aortic disruption is an uncommon but frequently emphasised condition in trauma management in the emergency department. We report a case in which a middle aged woman was hit by a moving vehicle, sustaining multiple severe injuries. Multidetector computed tomography revealed an unexpected but potentially fatal condition – traumatic aortic disruption. A pseudoaneurysm was detected over the aortic arch. In view of the multiple trauma, she was put on conservative treatment. Traumatic aortic disruption should be borne in mind during the emergency evaluation and management of unstable trauma victims, especially those with significant trauma mechanisms. Radiological evaluation plays an important diagnostic role.
NagyK., FabianT., RodmanG., FuldaG., RodriguezA., MirvisS.Guidelines for the diagnosis and management of blunt aortic injury: an EAST Practice Management Guidelines Work Group.J Trauma2000; 48(6): 1128–43.
KatyalD., McLellanB.A., BrennemanF.D., BoulangerB.R., SharkeyP.W., WaddellJ.P.Lateral impact motor vehicle collisions: significant cause of blunt traumatic rupture of the thoracic aorta.J Trauma1997; 42(5): 769–72.
4.
ShkrumM.J., McClaffertyK.J., GreenR.N., NowakE.S., YoungJ.G.Mechanisms of aortic injury in fatalities occurring in motor vehicle collisions.J Forensic Sci1999; 44(1): 44–56.
5.
MirvisS.E., BidwellJ.K., BuddemeyerE.U., DiaconisJ.N., PaisS.O., WhitleyJ.E.Value of chest radiography in excluding traumatic aortic rupture.Radiology1987; 163(2): 487–93.
6.
MirvisS.E., BidwellJ.K., BuddemeyerE.U., DiaconisJ.N., PaisS.O., WhitleyJ.E.Imaging diagnosis of traumatic aortic rupture. A review and experience at a major trauma center.Invest Radiol1987; 22(3): 187–96.
7.
MarnochaK.E., MaglinteD.D., WoodsJ., GoodmanM., PetersonP.Mediastinal-width/chest-width ratio in blunt chest trauma: a reappraisal.AJR Am J Roentgenol1984; 142(2): 275–7.
8.
MillerF.B., RichardsonJ.D., ThomasH.A., CryerH.M., WillingS.J.Role of CT in diagnosis of major arterial injury after blunt thoracic trauma.Surgery1989; 106(4): 596–603.
9.
DyerD.S., MooreE.E., IlkeD.N., McIntyreR.C., BernsteinS.M., DurhamJ.D.Thoracic aortic injury: how predictive is mechanism and is chest computed tomography a reliable screening tool? A prospective study of 1,561 patients.J Trauma2000; 48(4): 673–83.
10.
WickyS., CapassoP., MeuliR., FischerA., von SegesserL., SchnyderP.Spiral CT aortography: an efficient technique for the diagnosis of traumatic aortic injury.Eur Radiol1998; 8(5): 828–33.
PateJ.W., GavantM.L., WeimanD.S., FabianT.C.Traumatic rupture of the aortic isthmus: program of selective management.World J Surg1999; 23(1): 59–63.
14.
MaggisanoR., NathensA., AlexandrovaN.A., CinaC., BoulangerB., McKenzieR.Traumatic rupture of the thoracic aorta: should one always operate immediately?Ann Vasc Surg1995; 9(1): 44–52.
15.
FisherR.G., OriaR.A., MattoxK.L., WhighamC.J., PickardL.R.Conservative management of aortic lacerations due to blunt trauma.J Trauma1990; 30(12): 1562–6.
16.
WallM.J.Jr, SolteroE.Damage control for thoracic injuries.Surg Clin North Am1997; 77(4): 863–78.
17.
FabianT.C., DavisK.A., GavantM.L., CroceM.A., MeltonS.M., PattonJ.H.JrProspective study of blunt aortic injury: helical CT is diagnostic and antihypertensive therapy reduces rupture.Ann Surg1998; 227(5): 666–76.
18.
ShimW.H., KooB.K., YoonY.S., ChoiD., JangY., LeeD.Y.Treatment of thoracic aortic dissection with stent-grafts: midterm results.J Endovasc Ther2002; 9(6): 817–21.
