Presentation
Multiple trauma from a severe beating, now unresponsive. PH of hypertension.
Patient Data
Asymmetric widening of the left superior mediastinum on scout.
NECT: Extensive para-aortic and mediastinal hematoma widening the left superior mediastinum and displacing the trachea and esophagus. Normal pleural spaces.
Arterial phase: focal contained aortic tear in the distal arch at the isthmus and minor focal contrast medium extravasation.
3D reconstruction demonstrates a punched-out lesion.
Case Discussion
Asymmetric widening of the left superior mediastinum on trauma chest X-ray is a red flag for aortic injury.
Para-aortic and mediastinal hematoma indicates vascular injury and contrast medium is mandatory.
Blunt trauma can damage all layers of the aorta. Shearing injuries commonly occur at the isthmus where the aorta is tethered by the ligamentum arteriosum.
Urgent surgical repair may be life-saving and it is important not to over-resuscitate with fluids!
Unable to process the form. Check for errors and try again.