Traumatic aortic transection in a teenager presenting with hemorrhagic shock

Abstract

IntroductionBlunt chest trauma is usually associated with a rapid deceleration of the heart and aorta, leading to aortic injury and transection. The patients may be asymptomatic or present with non-specific clinical manifestations. Case presentationA 16-year-old male was brought to the emergency unite of our hospital by land ambulance intubated as a Level 1 trauma activation, after having fallen from the 4th floor of a housing block at midnight and landed on the ground. His blood pressure was: 88/56 mmHg, HR: 145 b/min, and RR: 35 cycle/min. The physical examination revealed Glasgow Coma Scale; E1M3V4, equally in diameter and reactive pupils with negative bilateral corneal reflexes. The thoracoabdominal CT images showed a type-4 transection in the descending aorta and a pseudoaneurysm of 8.5mm in diameter adjacent to the postvertebral segment of the left subclavian artery. The patient was successfully managed by the endovascular intervention. DiscussionThe clinical symptoms of aortic transection are non-specific. Thus the literature review and our findings highlight that the diagnosis of blunt thoracic aortic injury should be considered in any serious polytrauma in children. ConclusionTraumatic aortic transection is extremely rare in children than in adults and a potentially life-threatening condition with myriad clinical manifestations that may present as hemorrhagic shock. Computed tomography is an excellent imaging tool to assess the extent of the aortic injury and is used as a standard diagnostic method in cases of multiple trauma for the diagnosis of aortic transection. The endovascular repair can be used as a first-line treatment and open surgical therapy is best reserved for patients with a failed endovascular approach or complications of post-endovascular therapy and patients without an endovascular option.