Gonçalo Figueirôa (Lisbon / PT), Fernando Azevedo (Lisbon / PT), Miguel Fróis Borges (Lisbon / PT), José Teixeira (Lisbon / PT), Ana Alves Rafael (Lisbon / PT), Luís Viana Fernandes (Lisbon / PT)
Abstract text (incl. references and figure legends)
Blunt thoracic aortic injury (BTAI) has mortality rates up to 46% among patients who are alive upon hospital admission1. However, due to its rarity, strong evidence for its management lacks.
A 61-year-old man was brought to the emergency department after a high-energy motorcycle accident. He presented with chest and abdominal pain, and left chest deformation, but no signs of respiratory distress or external hemorrhage. He displayed severe hypotension and tachycardia, signs of malperfusion and hyperlactacidemia. D-Dimer count was of 122176ng/mL. Chest X-ray showed multiple rib fractures and left costophrenic angle obliteration, without significant hemothorax. Pelvic binder was in place, and X-ray confirmed a type III Anterior Posterior Compression Pelvic Fracture (Young-Burgess). Focused Assessment with Sonography in Trauma was unremarkable. The patient responded partially to massive transfusion, but no major source of bleeding was established initially. Body Computed Tomography (CT) showed an acute aortic dissection of the descending thoracic aorta with active bleeding to the left hemithorax. Upon multidisciplinary discussion, the patient was taken to the Operating Room and submitted to thoracic endovascular aortic repair (TEVAR) and osteotaxis of the pelvis through external fixation. He was afterwards admitted to the Intensive Care Unit (ICU) for hemodynamic stabilization. Left side hemothorax was drained with a chest tube. Reevaluation CT showed a well-positioned endoaortic prosthesis with no contrast leak. He was released from the ICU after 11 days and submitted to definite pelvic osteosynthesis 8 weeks after the injury. 3 months after the accident, the patient resumed normal activities.
BTAI requires immediate intervention. European databases are needed to establish evidence-based consensus guidelines.
1- Mouawad, N.J., Paulisin, J., Hofmeister, S. et al. Blunt thoracic aortic injury – concepts and management. J Cardiothorac Surg 15, 62 (2020).
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