What's the Diagnosis? By Dr. Lauren Murphy
A 48 year old male was the restrained driver in a high-speed motor vehicle collision with a tree. He presents to the ED with multiple pain complaints, he is awake on arrival to the ED, mildly tachycardic and BP104/53. He goes for CT scan. What’s the diagnosis? (scroll down for answer)
Answer: Thoracic aortic transection with surrounding mediastinal hematoma
- Imaging may reveal a widened mediastinum, loss of the normal aortic contour, depression of the left main bronchus, a left apical pleural cap, and or deviation of the trachea or NG tube to the right
- The most common lead off point in traumatic cases is the aortic isthmus, near the ligamentum arteriosum at the proximal portion of the descending thoracic aorta
- The majority of patients die at the scene of the accident
- In addition to trauma surgery, emergent consultation of both cardiothoracic surgery and interventional radiology may be required - repair involves surgery or stent grafting
- Click here for more images and information on thoracic aortic injuries.