IS Case 350: Traumatic pseudoaneurysm of the aortic arch

Nate Johnson, MD

Imaging Sciences URMC


2009 URMC Imaging Sciences
Publication Date: 2009-11-09

History

Patient is an 18-year-old male presenting status post-motor vehicle crash.

Findings

A 2.4 x 1.3 cm outpouching on the lateral side of the thoracic aorta just distal to the left subclavian artery takeoff.

Diagnosis

Traumatic pseudoaneurysm of the aortic arch

Discussion

Aortic injury is one of the most life threatening injuries that one may encounter. Eighty-five percent of these patients exsanguinate before reaching the hospital. Without intervention 80% of patients will die within one hour and 98% will die at 10 weeks.

Contrast enhanced CT with thin sections and multiplanar reformats is nearly 100% accurate in identifying aortic injury. Findings include: 1) Pseudoaneurysm; 2) Intimal flap; 3) Altered aortic contour; 4) Filling Defect; and 5) Rarely extravasation (patient likely would not have survived.)

Most common location for injury in CT: 1) Aortic isthmus (88%); 2) Aortic Arch with avulsed brachiocephalic (4.5%); 3) Descending Aorta (2%); and 4) Ascending Aorta (1%). Please note that ascending aortic tears are much more common overall than 1%, but patients rarely survive to obtain CT scan.

References

  1. Jeffrey RB. Diagnostic Imaging: Emergency. Amirsys, 2007.
  2. Gurney JD. Diagnostic Imaging: Chest. Amirsys, 2006.

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