Case 91

Aortic Transection

Presentation

A 21-year-old man presented with ankle and back pain after jumping from a four story building and landing on his feet. There was mild abdominal pain, a question of tenderness, and shortness of breath. The patient may also have lost consciousness for a short period of time. An emergency chest radiograph showed a left pneumothorax. A chest tube was inserted and chest symptoms were relieved. Neurologic exam was normal. Vital signs were stable.

Imaging Findings

Radiograph of the ankle

Radiograph of the spine

Chest Radiograph after placement of chest tube

CT of the spine

CT of Chest

Thoracic Aortography

Plain radiograph of the ankle shows comminuted fractures. Radiographs of the pelvis were normal. Radiograph of the spine shows burst fractures of L3 and L4 with widened interpediculate distance.

Chest radiograph shows the left pneumothorax has resolved. Left subcutaneous emphysema is demonstrated. There is possible widening of the mediastinum with indistinct borders. Tubes are in satisfactory position.

Computed tomography of the spine shows fractures of L3 and L4. Fracture fragments are protruding into the spinal canal .

Computed tomography studies of the head and the abdomen were normal.

Computed tomography of the thorax shows mediastinal hematoma .

Thoracic aortagram shows rupture of the aorta at the isthmus with a pseudoaneurysm formation.

Discussion

Falls from great heights result in decelerating injuries. Therefore, in addition to evaluation of the spine and bones, one must pay attention to the mediastinum for signs of aortic rupture.