Protected by what injured him

Abstract

A 38-year-old man presented to the hospital with chest pain and shortness of breath. He was wounded during a construction accident 11 h earlier. On admission, the patient’s vital signs were stable with a blood pressure of 106/61 mmHg and a tiny wound at the left second spatia intercostalia. Emergency coronary computed tomography angiography (Panel A) revealed a high-density shadow within the descending thoracic aorta inserted into the 11th thoracic vertebra. An emergency operation of aortic coarctation repair was performed, during which a broken common nail (Panel B) was observed to puncture through the descending thoracic aorta, penetrating half-way into the 11th thoracic vertebra. The amazing luck in this life-threatening accident is how the hard vertebrae stopped the nail. The nail had penetrated deeply enough to have secured itself from moving and rupturing the descending thoracic aorta walls; yet the vertebrae prevented it from having penetrated more deeply, just enough to not create an open wound on the anterior wall. As a result, the patient, fortunately, survived what was initially misdiagnosed as an abrasion, experiencing neither penetrating trauma nor massive haemorrhage hours after receiving inadequate treatments from a local emergency department before visiting our hospital as his chest and back pain persisted. He had an uneventful postoperative recovery and was doing well at a 3-month follow-up.