Figure - available from: Case Reports in Emergency Medicine
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Computed tomogram showing (a) 2 × 1 cm contrast-filled outpouching at the anterolateral aspect of the distal aortic arch with (b) associated mediastinal fat stranding and crescentic soft tissue density along the descending thoracic aorta.
Source publication
Background. Blunt thoracic aorta injury (BAI) is second only to head injury as cause of mortality in blunt trauma. While most patients do not survive till arrival at the hospital, for the remainder, prompt diagnosis and treatment greatly improve outcomes. We report an atypical presentation of BAI, highlighting the diagnostic challenges of this cond...
Citations
... [10] Rarely patients can present with delirium, an atypical presentation of BTAI. [11] A study done (by Rodriguez RM et al. l) showed that tenderness on palpation and chest pain at presentation had the highest sensitivity (90%) and hypoxia had the highest specificity (97%) for intrathoracic injury. [12] In patients with high-energy blunt trauma involving rapid deceleration with chest pain and tenderness, suspicion for BTAI should be high. ...
A 21-year-old lady presented following a high velocity road traffic accident as a pillion rider. She was hemodynamically stable at presentation and complained of chest pain which was considered to be due to the multiple rib fractures she had sustained. However, a computed tomography of the thorax showed a Society for Vascular Surgery Grade II aortic injury for which she underwent endovascular repair. This case reviews the various presentations of blunt trauma associated aortic injuries and the implications of emergent management.
... Some clinical features that suggest the presence of blunt thoracic aortic injury include hypotension, upper extremity hypertension, bilateral lower extremity pulse deficit, and initial chest tube output of >750 mL of blood. 12 Patients with this presentation have a high incidence of other significant injuries. However, these clinical features are unreliable for diagnosis of aortic injury as their absence cannot exclude the presence of the blunt aortic injury. ...
... However, these clinical features are unreliable for diagnosis of aortic injury as their absence cannot exclude the presence of the blunt aortic injury. 12 Thirty percent of patients with this injury have no external signs of chest trauma while 75% have rib fractures that draw attention away from the concomitant intrathoracic injury. 12 The subject of the present case had chest pain due to rib fracture and multiple significant spinal injuries due to the highenergy accident, thus any first responder should have treated this case as a potential blunt thoracic aortic injury. ...
... 12 Thirty percent of patients with this injury have no external signs of chest trauma while 75% have rib fractures that draw attention away from the concomitant intrathoracic injury. 12 The subject of the present case had chest pain due to rib fracture and multiple significant spinal injuries due to the highenergy accident, thus any first responder should have treated this case as a potential blunt thoracic aortic injury. ...
A 64-year-old male fell from an altitude of 10 m while paragliding after stalling due to the wind. The purpose of this case report is to describe the outcomes after multiple injuries sustained during a paragliding accident, including a potentially life-threating injury to the thoracic aorta. The subject sustained a bite wound on his tongue, injuries to his chest (left side) and back, and a right forearm deformity. Enhanced whole body computed tomography (CT) revealed fractures of the bilateral laminae of the second and third cervical bones, right first rib, the tenth thoracic vertebral body (compression type), second lumbar vertebral body (burst type) and the right radius, Other injuries included an injury to the thoracic aortic arch and the presence of intraabdominal fluid collection without perforation of the digestive tract. Endovascular treatment was selected for the aortic injury because of multiple injuries. Immediate management included hypotensive rate control therapy using calcium and a beta blocker. On the fourth hospital day, the subject underwent deployment of a stent-graft to the aorta and subsequent surgical immobilization for the lumbar burst fracture. He also underwent surgical immobilization of the radial fracture and was discharged on the 28th hospital day. First responders or physicians should consider the possibility of aortic injury when treating patients who suffer falls while paragliding and provide appropriate management. Failure to provide appropriate management of an aortic injury could result in death.
Level of evidence:
4.
