Alameda County Medical Center / Highland General Hospital
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Blunt Rupture of the Thoracic Aorta - A series of images demonstrating a contained aortic arch rupture (or traumatic pseudoaneurysm) in a 36 year old male driver of an automobile struck head-on at high speeds. He wore a lap belt and shoulder restraint but his vehicle was not equipped with an airbag. He presented with normal vital signs, complaining only of left posterior chest wall pain. |
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This initial AP supine chest x-ray demonstrates a slightly depressed left mainstem bronchus, a rightward-deviated trachea, and an indistinct aortic knob contour. Notice that the mediastinum, despite the magnification inherent in the AP projection, is not markedly widened. |
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Spiral CT
scan of the mediastinum using intravenous contrast.
This cut through the aortic arch shows portions of the ascending and descending aorta of normal contour and caliber. |
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This next cut, 0.5 cm below the previous one, demonstrates the beginning of the traumatic pseudoaneurysm of the descending arch, with its intimal flap plainly visible (arrow) | ||
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The full extent of the contained aortic rupture (pseudoaneurysm) is evident as it projects anteromedially from the descending arch at the ligamentum arteriosum, just distal to the origin of the left subclavian artery. | ||
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The next cut is below the level of injury, with the caliber and contour of the descending arch back to normal. | ||
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The digital subtraction angiogram shows the pseudoaneurysm at the proximal descending aortic arch. | ||
| The patient underwent prompt "clamp and sew" repair of the partially transected aorta via a left anterolateral thoracotomy. His recovery was uneventful. | |||
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