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Blunt thoracic aortic injury resulting in free rupture into the pleural space and cardiac arrest, managed successfully with endovascular stenting
  1. Nithya Niranjan1,
  2. Priyadharshani Samarasinghe2,
  3. Delfino Di Mascio3 and
  4. Jeremy M Hsu2
  1. 1Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia
  2. 2Department of Trauma Surgery, Westmead Hospital, Westmead, New South Wales, Australia
  3. 3Department of Vascular Surgery, Westmead Hospital, Westmead, New South Wales, Australia
  1. Correspondence to Dr Nithya Niranjan; nithya.n811{at}gmail.com

Abstract

Blunt thoracic aortic injury (BTAI) is an uncommon yet serious diagnosis in trauma patients, with high on-scene mortality. BTAI typically occurs from rapid deceleration such as in motor vehicle collisions or high-altitude falls shearing the aorta just proximal to the ligamentum arteriosum. We report a case of a man in his 50s falling from a height of 15 m who presented hypotensive with retrosternal chest pain. Mobile chest X-ray showed a widened mediastinum with left-sided haemothorax. CT revealed a contained free aortic rupture just inferior to the origin of the left subclavian artery with bleeding into the mediastinum and left pleural space. The patient underwent urgent thoracic endovascular aortic repair (TEVAR) but arrested on-table due to a left-sided tension haemothorax requiring chest-drain decompression and haemostatic resuscitation. After return of spontaneous circulation, TEVAR was successfully performed. BTAI is a dynamic process; hence, timely imaging and minimally invasive surgical treatment are key to patients surviving grade III and IV aortic injuries.

  • Vascular surgery
  • Surgery
  • Orthopaedic and trauma surgery
  • Trauma

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Footnotes

  • Contributors NN wrote the initial draft of the case report. PS provided ongoing feedback on drafts, which NN actioned. DDM provided specialist vascular input regarding rationale for operation and feedback on drafts. JMH also provided feedback on drafts and the final opinion on when the report was suitable for publication.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.