Presentation
Motor vehicle collision.
Patient Data
Widening of the superior mediastinum. Otherwise negative chest x-ray.
Focal traumatic dissection of the aortic isthmus with associated pseudoaneurysm measuring approximately 2.3 x 2.0 cm. No active extravasation. No large mediastinal hematoma.
Angiography obtained before endovascular repair of the aorta redemonstrates traumatic aortic injury. Images obtained during endovascular repair shows the stent predeployment. A third series of images were obtained after successful endovascular repair.
Tracheostomy tube and NG tube appropriately positioned status post endovascular repair of traumatic aortic injury. Left pleural effusion, bibasilar atelectasis.
Case Discussion
This patient presented following a motor vehicle collision with blunt force trauma to the chest, GCS of 5, and hemodynamic instability, found to have traumatic aortic dissection on CT chest. Traumatic aortic injuries are a major cause of mortality in motor vehicle collisions involving rapid deceleration and blunt trauma, most causing fatality at the scene. They are classified based on the degree of changes in external structure of the aorta, this patient presenting with type III abnormality or pseudoaneyrysm. Emergency surgical repair is indicated in type III and type IV (full rupture) aortic dissections most often with thoracic endovascular aortic repair (TEVAR), which has shown reduced negative outcomes and mortality compared to open repair.
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