Question

25 year-old male was struck by a car while crossing the street. Chest X-ray and CT Chest with 3D reconstruction are shown below. What's the diagnosis? 

Answer

Answer: Aortic dissection / transection

 

Blunt Aortic Injury

• Occurs in < 1% of MVCs; causes 16% of blunt trauma deaths overall.
• 80% die before reaching hospital; 30% who survive to hospital will die if missed.
• Ligamentum arteriosum is the most common site of injury
• CXR: widened mediastinum (suggestive);  CT angiography is diagnostic (CT with 3D reconstruction below; arrow below indicates defect).
• Treatment: Beta-blocker infusion (e.g., esmolol) +/- vasodilator to keep the heart rate <60 BPM and systolic blood pressure 120 mmHg; both temporizing measures until surgical correction can be performed 
• Debate whether open aortic repair or TEVAR (Thoracic EndoVascular Aortic Repair) results in the best outcomes.  

References

Follow me on Twitter (@criticalcarenow) and Google+ (+haney mallemat)