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Atypical presentation of traumatic aortic injury
Andrew Fu Wah Ho1, Tallie Wei-Lin Chua2, Puneet Seth3
1SingHealth Emergency Medicine Residency Program, Singapore Health Services, 167 Jalan Bukit Merah No. 17-10 Tower 5, Singapore 150167 ; Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608.
Case Reports in Emergency Medicine
|January 23, 2015
Summary
Blunt thoracic aorta injury (BAI) can present atypically, challenging emergency diagnosis. Early suspicion and advanced imaging are crucial for timely intervention and improved outcomes in patients with this severe trauma.
Area of Science:
- Trauma Surgery
- Emergency Medicine
- Cardiovascular Surgery
Background:
- Blunt thoracic aorta injury (BAI) is a leading cause of mortality in blunt trauma.
- Prompt diagnosis and treatment significantly improve outcomes for survivors.
- Atypical presentations can delay diagnosis in the emergency department.
Purpose of the Study:
- To highlight diagnostic challenges of atypical blunt thoracic aorta injury.
- To emphasize the importance of high index of suspicion for early diagnosis.
- To discuss the utility of clinical features and imaging in BAI diagnosis.
Main Methods:
- Case report of a 25-year-old male with delayed presentation of BAI.
- Review of clinical features, injury mechanism, and radiographic findings.
- Utilized sonography, chest radiograph, and CT for diagnosis.
- Described percutaneous endovascular thoracic aortic repair.
Main Results:
- A hemodynamically stable patient presented with delirium 15 hours post-injury.
- Initial chest imaging (sonography, radiograph) was non-specific.
- CT scan revealed a contained distal aortic arch disruption.
- Successful endovascular repair led to good recovery.
Conclusions:
- BAI can present with subtle or absent classic signs and symptoms.
- A high index of suspicion is critical for identifying BAI.
- Integrating mechanism of injury, clinical presentation, and imaging is key.
- Advanced imaging should be considered promptly in suspected cases.
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