UMEM Educational Pearls

Title: What's the Diagnosis? Written by Zachary Dezman

Posted: 7/30/2012 by Haney Mallemat, MD
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Question

25 year-old male was struck by a car while crossing the street. Chest X-ray and CT Chest with 3D reconstruction are shown below. What's the diagnosis?

Answer

Answer: Aortic dissection / transection

Blunt Aortic Injury

Occurs in < 1% of MVCs; causes 16% of blunt trauma deaths overall.
80% die before reaching hospital; 30% who survive to hospital will die if missed.
Ligamentum arteriosum is the most common site of injury
CXR: widened mediastinum (suggestive); CT angiography is diagnostic (CT with 3D reconstruction below; arrow below indicates defect).
Treatment: Beta-blocker infusion (e.g., esmolol) +/- vasodilator to keep the heart rate <60 BPM and systolic blood pressure 120 mmHg; both temporizing measures until surgical correction can be performed
Debate whether open aortic repair or TEVAR (Thoracic EndoVascular Aortic Repair) results in the best outcomes.

References

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