CASE 1336 Published on 10.09.2003
0

Traumatic dissection of the aortic isthmus treated with an intravascular stent

Section

Cardiovascular

Case Type

Clinical Cases

Authors

Cademartiri F, Salamousas BV, Luccichenti G, Pavone P

Connected authors
Patient

63 years, female

Categories
No Area of Interest ; Imaging Technique CT, CT, MR
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Clinical History
Patient with deceleration car accident and blunt thoracic trauma.
Imaging Findings
The patient was involved in a car accident with a deceleration kinetic. Clinically there was a severe blunt thoracic trauma. A spiral CT scan was performed in another hospital and a traumatic rupture of the aortic isthmus was suspected. Then the patient was transferred to our institution for surgical treatment, but it was decided to use an intra-vascular approach.
Discussion
Most patients with traumatic lesions of the thoracic aorta die on the accident site, nevertheless 13-15% of these patients arrive at hospital with present vital signs present.
In patients who survive until they are admitted to hospital, the highest risk of complete rupture of the aorta is in the first 4 hours after the accident. Mortality can reach 80%. Later deaths are due to associated damage or to multiple organ failure.
An aortic lesion must be suspected if on admission the patient shows:
hypotension, left haemothorax, hypertension in the upper extremities or a left supra-clavicular haematoma.
The treatment is still controversial. Medical, endovascular or surgical procedures have been proposed, although the lack of wide and standardised studies prevent selection of the best protocol.
In this case the patient was treated with a stent. The result was therapeutically effective.
Differential Diagnosis List
Dissection of the aortic isthmus with endovascular treatment
Final Diagnosis
Dissection of the aortic isthmus with endovascular treatment
Case information
URL: https://www.eurorad.org/case/1336
DOI: 10.1594/EURORAD/CASE.1336
ISSN: 1563-4086
Figure 1

Spiral CT performed at admission for diagnosis

Spiral CT performed at admission for diagnosis
At the level of the aortic arch there are no evident signs of dissection.
Spiral CT performed at admission for diagnosis
Slightly caudal slice which demonstrates an intimal flap in the ventral portion of the aortic isthmus.
Spiral CT performed at admission for diagnosis
Axial slice at the level of the tracheal carina which shows the intimal flap.
Spiral CT performed at admission for diagnosis
At the level of the main pulmonary artery a minimal intimal flap is still evident.
Figure 2

Coventional DSA performed for the positioning of the stent

Coventional DSA performed for the positioning of the stent
The panoramic view shows the correspondence to the spiral CT diagnosis. An enlargement of the ventral portion on the aortic isthmus is present.
Coventional DSA performed for the positioning of the stent
Measurement in preparation for stent positioning.
Coventional DSA performed for the positioning of the stent
The angiographic control after the positioning of the stent. No evidence of residual dissection or pseudoaneurysmal dilatation.
Figure 3

Spiral CT scan performed after endovascular treatment

Spiral CT scan performed after endovascular treatment
The aortic arch is normal.
Spiral CT scan performed after endovascular treatment
The isthmus is normal.
Spiral CT scan performed after endovascular treatment
The beginning of the descending aorta is normal.
Spiral CT scan performed after endovascular treatment
The oblique sagittal MPR shows the success of the procedure.