Fang Xiao-Xin, Wu Xin-Hui, Chen Xiao-Feng
Department of Cardiology, Taizhou Hospital of Zhejiang Province (Taizhou Hospital, Zhejiang University School of Medicine), Linhai 317000, Zhejiang Province, China.
Department of Orthopedics, Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China.
World J Clin Cases. 2022 May 26;10(15):4998-5004. doi: 10.12998/wjcc.v10.i15.4998.
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 10 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.
钝性主动脉损伤是一种特殊类型的主动脉疾病。由于其发病率低、院前死亡率高以及漏诊概率高，及时识别在初始损伤中存活下来的钝性主动脉损伤患者一直是一项临床挑战。
我们报告一例创伤性主动脉假性动脉瘤合并右髂动脉夹层动脉瘤的病例，该病例在交通事故发生3个月后被诊断出来。患者为一名76岁男性，在过马路时被一辆快速行驶的四轮机动车撞倒（损伤机制为侧面撞击）。他在当地医院接受了胸部、颅脑计算机断层扫描（CT）及全腹部增强CT检查。图像显示蛛网膜下腔出血、右额顶部头皮血肿、右锁骨及第二肋骨骨折、胸主动脉前降段外侧肿块状纵隔阴影（纵隔血肿）、肠系膜血管损伤伴血肿形成、骨盆骨折以及左骶髂关节半脱位。骨盆骨折采用外固定支架固定后，他被转至我院进一步治疗。在我院，他成功接受了小肠部分切除术及CT引导下左骶髂关节螺钉内固定术，随后返回当地医院进行康复治疗。然而，自事故发生以来，患者一直有轻度胸痛，但未引起临床医生的重视。在康复期间，他的胸痛逐渐加重，当地医院进行的胸主动脉计算机断层扫描血管造影显示主动脉弓起始降段有假性动脉瘤。转至我院后，术前评估偶然发现右髂外动脉夹层动脉瘤。最终，患者接受了血管内支架植入修复术，并于术后第10天出院。随访4年未发现明显内漏。
我们强调，急诊创伤中心应考虑严重机动车碰撞患者发生主动脉损伤的可能性，并在必要时重复检查以避免漏诊。
