Abstract
Blunt thoracic aortic injuries are potentially lethal. Those who survive may form an organised haematoma in the periadventitial space resulting in a pseudoaneurysm, which may be identified incidentally decades later. While the role of thoracic endovascular aortic repair (TEVAR) in acute settings has been established, its role in chronic cases is yet to be defined. We report three cases that were diagnosed incidentally six, nine and 18 years after the injury. Two were managed by TEVAR while the third declined intervention and is on annual follow-up. Patients with asymptomatic and stable pseudoaneurysms of the descending thoracic aorta should be offered surveillance versus TEVAR because the risk of rupture is not negligible, whilst taking into account the patient’s level of physical activity. These three cases highlight the importance of early diagnosis of aortic injuries in blunt trauma and its grading.
Highlights
Blunt thoracic aortic injuries are potentially lethal. Those who survive may form an organised haematoma in the periadventitial space resulting in a pseudoaneurysm, which may be identified incidentally decades later
In 2015, a 37-year-old male patient was referred to Sultan Qaboos University Hospital (SQUH) with findings of a widened mediastinum on a chest X-ray performed for a routine health screening for his promotion as an army officer
Case Three In May 2019, a 29-year-old male patient was referred to SQUH with an incidental finding of a pseudoaneurysm of the descending thoracic aorta [Figure 4]
Summary
In 2015, a 37-year-old male patient was referred to Sultan Qaboos University Hospital (SQUH) with findings of a widened mediastinum on a chest X-ray performed for a routine health screening for his promotion as an army officer. The patient had a history of a motor vehicle collision (MVC) 18 years prior to presentation when he had undergone a laparotomy and splenectomy Following these surgeries, he carried on regular official and recreational activities in the army with no restrictions. His latest CTA in January 2020 showed no thrombus progression and no complications related to the stent-graft He will be continued on antiplatelet therapy as long as there is evidence of thrombus on annual imaging. He continues his army activities with a reduction in physical intensity and contact sport
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