Published online May 26, 2022. doi: 10.12998/wjcc.v10.i15.4998
Peer-review started: November 6, 2021
First decision: February 7, 2022
Revised: February 19, 2022
Accepted: March 27, 2022
Article in press: March 27, 2022
Published online: May 26, 2022
Blunt aortic injury is a special type of aortic disease. Due to its low incidence, high prehospital mortality and high probability of leakage diagnosis, the timely identification of patients with blunt aortic injury who survive the initial injury has always been a clinical challenge.
We report a case of traumatic aortic pseudoaneurysm with right iliac artery dissection aneurysm that was diagnosed 3 mo after a traffic accident. The patient is a 76-year-old male who was knocked down by a fast-moving four-wheel motor vehicle while crossing the road (the damage mechanism was side impact). He received chest, cranial computed tomography (CT) and whole abdomen enhanced CT in the local hospital. The images suggested subarachnoid hemorrhage, right frontoparietal scalp hematoma, fracture of the right clavicle and second rib, lump-shaped mediastinal shadow outside the anterior descending thoracic aorta (mediastinal hematoma), mesenteric vascular injury with hematoma formation, pelvic fracture, and subluxation of the left sacroiliac joint. After the pelvic fracture was fixed with an external stent, he was sent to our hospital for further treatment. In our hospital, he successfully underwent partial resection of the small intestine and CT-guided screw internal fixation of the left sacroiliac joint and returned to the local hospital for rehabilitation treatment. However, since the accident, the patient has been suffering from mild chest pain, which has not aroused the attention of clinicians. During rehabilitation, his chest pain gradually worsened, and the thoracic aorta computed tomography angiography performed in the local hospital showed a pseudoaneurysm in the initial descending segment of the aortic arch. After transfer to our hospital, a dissecting aneurysm of the right external iliac artery was incidentally found in the preoperative evaluation. Finally, endovascular stent graft repair was performed, and he was discharged on the 10th day after the operation. No obvious endo-leak was found after 4 years of follow-up.
We highlight that emergency trauma centers should consider the possibility of aortic injury in patients with severe motor vehicle crashes and repeat the examination when necessary to avoid missed diagnoses.
Core Tip: The era of high-speed motor vehicles has brought an increase in the incidence of blunt aortic injury, and the high mortality rate from traumatic aortic injury points toward vigilance. We report a 76-year-old man who was diagnosed with traumatic aortic pseudoaneurysm with right iliac artery dissection aneurysm 3 mo after severe trauma due to mild chest pain that gradually worsened. After interventional surgery, resolution of symptoms was observed, and there were no long-term complications. The aim of our case report is to alert clinicians to identify aortic injuries in light of history and diagnosing symptoms for proper treatment and the prevention of complications and mortality.