Conservative management of subdiaphragmatic aortic trauma

Traumatic rupture of the thoracic aorta is most frequently caused by rapid deceleration during road traffic accidents, with the aortic isthmus representing the most common site of injury. Isolated post-traumatic distal aortic haematomas remain rare. Their clinical management is highly challenging, particularly when the regional aortic diameter is narrow. We report the case of a 26-year-old man who survived a violent motor vehicle collision involving a two-vehicle impact. Upon presentation, he was haemodynamically and neurologically stable. A thoraco-abdominal computed tomography scan revealed an intramural haematoma in the subdiaphragmatic aorta, along with a hepatic contusion, a splenic contusion, and a spinal fracture. Post-processing image analysis performed on a workstation determined the aortic diameters above and below the lesion to be 16.3 mm and 14.7 mm, respectively. The patient was successfully managed conservatively with structured clinical and radiological follow-up.