Penetrating aortic injury is the second most common type of aortic injury after blunt trauma. Stab wounds and gunshot wounds are the two most common penetrating mechanisms. 
Typically, thoracic aortic injury is associated with a very poor prognosis with 92.3% mortality compared to 76.1% for abdominal aortic injuries ¹.

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 case, the knife wound has penetrated from the anterior chest through to the aortic arch. There is contrast extravasating into the mediastinum, with a flap of hypodense intimal tissue in the lumen of the aorta. There is gross haemomediastinum.
Case contributed by A/Prof. Pramit Phal.