Unusual Presentation of a Penetrating Aortic Arch Injury

• Main Authors: Fikret Sami Vural, Atul Kumar Patel, Kashif Mustafa
• Format: Article
• Language: English
• Published: Korean Society for Thoracic and Cardiovascular Surgery 2017-08-01
• Series: Korean Journal of Thoracic and Cardiovascular Surgery
• Subjects: Aorta; thoracic; Hypothermia; Circulatory arrest deep hypotermia induced; Penetrating trauma
• Online Access: http://www.kjtcvs.org/journal/download_pdf.php?doi=10.5090/kjtcs.2017.50.4.295

A 27-year-old man was admitted with a penetrating injury at the mid-manubrium. Computed tomographic (CT) angiography s howed a f illing def ect in t he a ortic arch. This was e valuated a s a sign o f injury and the patient underwent an e mergency o peration. No a ctive bleeding o r clot w as f ound in t he m ediastinum d uring the operation. The laceration point was between the innominate and the left carotid artery posteriorly. The injury was approached using hypothermic circulatory arrest. Aortotomy and exploration showed a 2-cm-long full-thickness aortic injury with an overlying clot. A filling defect on angiography as a sign of a penetrating arch injury has never been reported previously, but was the main pathological finding on CT angiography in our case. The aorta is a high-pressure system and injuries to it should be treated aggressively.