PMC8008191_01
PMC8008191_02
(a) Chest radiography in a 36-year-old male patient involved in a motor vehicle accident. There is widening of the mediastinum (arrow) with a left apical pleural cap (star) and veiling of the left lung field in keeping with a left haemothorax. There is depression of the left main bronchus (triangle), and the silhouette of the aortic knuckle is maintained. (b) Computed tomography angiography demonstrating a mediastinal haematoma (star) and a type 2 aortic injury with an intimal flap and a pseudoaneurysm (arrow). (c) Digital subtraction angiogram image prior to stenting delineating the false aneurysm (arrows) beyond the origin of the left subclavian artery. (d) Digital subtraction angiogram image post successful endovascular aneurysm repair with the stent in place (arrow). (e) Follow-up computed tomography angiography indicates the stent in place with no complications (arrow).
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Signs of mediastinal haemorrhage on chest radiography were observed in the first patient (Figure 1a). Computed tomography angiography was proposed by the emergency physician, and it clearly confirmed the site of traumatic aortic injury at the region of aortic isthmus, a Grade 2 injury of the aorta with formation of a false aneurysm (Figure 1b). The digital subtraction angiogram (DSA) confirmed the presence of a false aneurysm, which was treated surgically with endovascular aneurysm repair (EVAR) (Figure 1c & 1d). The patient recovered completely, and a follow-up CTA (Figure 1e) after 6 months revealed no complications.
PMC8008191_03
(a) Chest radiography in a 23-year-old male involved in a pedestrian vehicle accident indicates a widened mediastinum (arrow), loss of the aortic knuckle (star), retro-cardiac double density and a widened right paraspinal line (triangle). (b) Coronal computed tomography angiography image with a type 2 aortic injury, complicated by thrombus formation (arrow). Also note the large mediastinal haematoma (star). (c) Sagittal digital subtraction angiogram after endovascular aneurysm repair with the stent in place (arrow). (d) Follow-up computed tomography angiography post stenting. (e) Sagittal computed tomography angiography abdomen demonstrating subtle thrombus within the coeliac artery (arrow). (f) Segmental infarction revealed within the right kidney (arrow).
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The initial chest radiograph revealed signs of aortic injury (Figure 2a), which was confirmed by CTA as a Grade 2 injury at the aortic isthmus (Figure 2b), followed by successful DSA and EVAR (Figure 2c & 2d). The patient, however, later developed complications secondary to emboli from the EVAR site with peripheral thrombosis in the coeliac artery and its distribution and an infarction in the right kidney, from which he partially recovered (Figure 2e & 2f).
PMC8008191_04
(a) Chest radiography in a 22-year-old male involved in a motor vehicle accident as a front passenger with a widened right paraspinal line (arrow), widened mediastinum (star) and depression of the left main bronchus, all signs pointing towards a vascular injury. Also note the tension pneumothorax on the left (circle) with contralateral mediastinal shift. (b) Computed tomography angiography in the same patient indicating the aortic injury and false aneurysm (arrow) at the isthmus. (c) Initial digital subtraction angiogram image pre-stenting revealing the pseudoaneurysm (arrow). (d) Digital subtraction angiogram image with the stent in place (arrow). (e) Follow-up computed tomography angiography demonstrating a leak around the stent (arrow). (f) A second endovascular stent was placed to treat the endoleak, sagittal oblique digital subtraction angiogram image with double stents (arrow).
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PMC8008191_05
(a) A 45-year-old male jumped from the fourth floor and sustained multiple injuries. Initial computed tomography angiography revealed a traumatic type 2 aortic injury with an intimal flap, thrombus and false aneurysm (arrow). (b) Sagittal oblique digital subtraction angiogram image with the stent in place (arrow). No complications seen.
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He was stented for a type 2 aortic injury (Figure 4a & 4b), which was complicated by a leak, and he required stent repositioning and balloon angioplasty.