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Case Reports in Emergency Medicine
Volume 2014 (2014), Article ID 864301, 3 pages
http://dx.doi.org/10.1155/2014/864301
Case Report

Atypical Presentation of Traumatic Aortic Injury

1SingHealth Emergency Medicine Residency Program, Singapore Health Services, 167 Jalan Bukit Merah No. 17-10 Tower 5, Singapore 150167
2Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608

Received 24 November 2014; Revised 16 December 2014; Accepted 16 December 2014; Published 30 December 2014

Academic Editor: Serdar Kula

Copyright © 2014 Andrew Fu Wah Ho et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. Blunt thoracic aorta injury (BAI) is second only to head injury as cause of mortality in blunt trauma. While most patients do not survive till arrival at the hospital, for the remainder, prompt diagnosis and treatment greatly improve outcomes. We report an atypical presentation of BAI, highlighting the diagnostic challenges of this condition in the emergency department. Case Presentation. A previously well 25-year-old male presented 15 hours after injury hemodynamically stable with delirium. There were no signs or symptoms suggestive of BAI. Sonography showed small bilateral pleural effusions. Chest radiograph showed a normal mediastinum. Eventually, CT demonstrated a contained distal aortic arch disruption. The patient underwent percutaneous endovascular thoracic aortic repair and recovered well. Conclusion. This catastrophic lesion may present with few reliable signs and symptoms; hence, a high index of suspicion is crucial for early diagnosis and definitive surgical management. This paper discusses the diagnostic utility of clinical features, injury mechanism, and radiographic modalities. Consideration of mechanism of injury, clinical features, and chest radiograph findings should prompt advanced chest imaging.