Abstract
Blunt traumatic injury and acute dissection of thoracic aorta is increasing in incidence in seriously multi-trauma patients, remaining highly lethal. Early identification and repair is the key to a successful outcome. We report an unusual case of a 62-year-old man involved in a motor vehicle accident after subarachnoid hemorrhage due to an intracranial artery aneurysm rupture. The post-traumatic aorta dissection was overlooked during the initial evaluation and was found incidentally later during an attempt for endovascular treatment of the intracranial aneurysm. The pitfalls in the diagnostic approach of this patient are discussed and the paramount importance of the correct interpretation of all the available clinical and investigational findings in multiple injured patients are highlighted.
Highlights
Multiply-injured patients are always a diagnostic and therapeutic clinical challenge
The first was the misdiagnosis of posttraumatic instead of aneurismal subarachnoid hemorrhage, which was the actual cause of the accident
This was due to the inability of the patient to describe the event due to retrograde posttraumatic amnesia as well as due to the inexperience of the admitting physician to identify the hinds of the brain CT scan indicating the aneurismal origin of the subarachnoid hemorrhage
Summary
Multiply-injured patients are always a diagnostic and therapeutic clinical challenge. Thoracic descending aorta was noted, just distal to the origin of the left subclavian artery The combination of these findings with the bruise in the upper left chest, made us suspicious of an aortic injury. The patient was woken up and a chest CT followed, which confirmed the diagnosis of a post-traumatic dissection of the descending aorta He was transferred to the cardio-thoracic unit and an aortic stent was successfully deployed for endovascular repair of the dissection (Figure 4). A posttraumatic dissection aneurysm of the right common carotid artery (CCA) at its cervical segment was found (Figure 5C) This was clinically silent, treated conservatively at that stage [3] and the patient was eventually discharged three weeks after the primary event. The right CCA dissection aneurysm was endovascularly treated using platinum coils, as it showed no signs of regression [2,3]
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