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Chronic Thoracic Aortic Aneurysm Presenting 29 Years following Trauma.

Miller S, Kumar P, Van den Bosch R, Khanafer A - Case Rep Surg (2015)

Bottom Line: Blunt, nonpenetrating injuries of the thoracic aorta are uncommon and associated with a high mortality rate within the first hour.We present a case in which a chronic thoracic aortic aneurysm was diagnosed 29 years following a significant motor vehicle accident.Our case illustrates an important clinical lesson; a past medical history of trauma should not be overlooked at any patient assessment.

View Article: PubMed Central - PubMed

Affiliation: General Surgery, Timaru Hospital, South Canterbury 7910, New Zealand.

ABSTRACT
Blunt, nonpenetrating injuries of the thoracic aorta are uncommon and associated with a high mortality rate within the first hour. Aortic injury is missed in 1-2% of patients that survive to hospital, and a chronic thoracic aortic aneurysm may subsequently form. We present a case in which a chronic thoracic aortic aneurysm was diagnosed 29 years following a significant motor vehicle accident. We discuss the epidemiology, presentation, and management of this uncommon consequence of blunt, nonpenetrating aortic injury. Our case illustrates an important clinical lesson; a past medical history of trauma should not be overlooked at any patient assessment.

No MeSH data available.


Related in: MedlinePlus

Transverse computed tomography imaging. Dense calcifications can be seen within the aneurysm wall.
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fig3: Transverse computed tomography imaging. Dense calcifications can be seen within the aneurysm wall.

Mentions: Electrocardiogram (ECG) demonstrated normal sinus rhythm with no evidence of ischaemia. Routine blood tests including hsTroponin T were within normal range. Chest X-ray (CXR) revealed clear lung fields with a normal cardiothoracic ratio (Figure 1). There was a smooth enlargement of the left hilum on CXR, most likely due to an enlarged main pulmonary artery; further evaluation was advised. Subsequent computed tomography (CT) imaging of the chest revealed however a 5.4 cm saccular thoracic aneurysm originating from the aortic arch near to the left subclavian artery origin (Figures 2, 3, and 4). The appearance of peripheral calcifications suggested that the aneurysm was long-standing and therefore an unlikely cause of the patient's acute symptoms which settled in the emergency department with no specific management. There was no perianeurysmal fluid collection and no evidence of rupture. CT angiogram of the thoracic aorta confirmed the findings and indicated that the proximal margin of the aneurysm lay adjacent to the posterior origin of the left subclavian artery and was 19 mm downstream from the posterior margin of the left common carotid artery. Imaging of the circle of Willis and carotids demonstrated an intact vertebrobasilar confluence.


Chronic Thoracic Aortic Aneurysm Presenting 29 Years following Trauma.

Miller S, Kumar P, Van den Bosch R, Khanafer A - Case Rep Surg (2015)

Transverse computed tomography imaging. Dense calcifications can be seen within the aneurysm wall.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4550747&req=5

fig3: Transverse computed tomography imaging. Dense calcifications can be seen within the aneurysm wall.
Mentions: Electrocardiogram (ECG) demonstrated normal sinus rhythm with no evidence of ischaemia. Routine blood tests including hsTroponin T were within normal range. Chest X-ray (CXR) revealed clear lung fields with a normal cardiothoracic ratio (Figure 1). There was a smooth enlargement of the left hilum on CXR, most likely due to an enlarged main pulmonary artery; further evaluation was advised. Subsequent computed tomography (CT) imaging of the chest revealed however a 5.4 cm saccular thoracic aneurysm originating from the aortic arch near to the left subclavian artery origin (Figures 2, 3, and 4). The appearance of peripheral calcifications suggested that the aneurysm was long-standing and therefore an unlikely cause of the patient's acute symptoms which settled in the emergency department with no specific management. There was no perianeurysmal fluid collection and no evidence of rupture. CT angiogram of the thoracic aorta confirmed the findings and indicated that the proximal margin of the aneurysm lay adjacent to the posterior origin of the left subclavian artery and was 19 mm downstream from the posterior margin of the left common carotid artery. Imaging of the circle of Willis and carotids demonstrated an intact vertebrobasilar confluence.

Bottom Line: Blunt, nonpenetrating injuries of the thoracic aorta are uncommon and associated with a high mortality rate within the first hour.We present a case in which a chronic thoracic aortic aneurysm was diagnosed 29 years following a significant motor vehicle accident.Our case illustrates an important clinical lesson; a past medical history of trauma should not be overlooked at any patient assessment.

View Article: PubMed Central - PubMed

Affiliation: General Surgery, Timaru Hospital, South Canterbury 7910, New Zealand.

ABSTRACT
Blunt, nonpenetrating injuries of the thoracic aorta are uncommon and associated with a high mortality rate within the first hour. Aortic injury is missed in 1-2% of patients that survive to hospital, and a chronic thoracic aortic aneurysm may subsequently form. We present a case in which a chronic thoracic aortic aneurysm was diagnosed 29 years following a significant motor vehicle accident. We discuss the epidemiology, presentation, and management of this uncommon consequence of blunt, nonpenetrating aortic injury. Our case illustrates an important clinical lesson; a past medical history of trauma should not be overlooked at any patient assessment.

No MeSH data available.


Related in: MedlinePlus