Uncommon traumatic anterior aortic dissection in the context of a blunt trauma

Abstract

© BMJ Publishing Group Limited 2021. No commercial reuse. See rights and permissions. Published by BMJ. DESCRIPTION This 79yearold woman was involved in a road traffic collision in which another driver rearended her stationary car at a speed of around 70 m/h. She was transferred to the nearest Major Trauma Centre, where her observations remained stable and initial primary survey was unremarkable. She had a full trauma CT that revealed extensive bilateral rib fractures with flail of 8+9 on the left, a C4-5 body fracture and, most significantly an acute traumatic pseudoaneurysm of the thoracic aorta and associated pneumomediastinum. The CT images show transverse and coronal views of this pseudoaneurysm. On the coronal views(figure 1), you can see a bulging of the anterior wall of the thoracic aorta, just below the level of the isthmus. On the transverse view(figure 2), you can see the lumen of the aorta (indicated by an arrow), with a false lumen demonstrating dissection of this vessel. A discussion was held with interventional radiology, who recommended endovascular stenting of the injured aorta under general anaesthetic to minimise the chances of future rupture. The anaesthetic team however deemed her very high risk given her trauma burden coupled with her advanced age and significant preexisting comorbidities. They advised us that she was unlikely to survive a general anaesthetic. This was discussed fully with the patient who did not want to risk a general anaesthetic, due to the low probability of survival, before she has had the chance to see her family. She was therefore admitted to the ward with an Aspen collar for her C4-5 fracture and