Traumatic aortic injury from pellet gun: A case report
Acute traumatic aortic injuries are of the most lethal sequelae of penetrating thoracic injuries and require rapid detection and management. The American College of Radiology currently recommends the use of noncontrast CT, followed by computed tomography angiography (CTA) as the first-line imaging m...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-03-01
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| Series: | Radiology Case Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1930043322008925 |
| _version_ | 1811176145164435456 |
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| author | Paul Johnson, Bachelor of Science Ryan Anderson, Bachelor of Science Collin Gamble, MD Eric van Bogaert, MD Jonathan Joshi, MD |
| author_facet | Paul Johnson, Bachelor of Science Ryan Anderson, Bachelor of Science Collin Gamble, MD Eric van Bogaert, MD Jonathan Joshi, MD |
| author_sort | Paul Johnson, Bachelor of Science |
| collection | DOAJ |
| description | Acute traumatic aortic injuries are of the most lethal sequelae of penetrating thoracic injuries and require rapid detection and management. The American College of Radiology currently recommends the use of noncontrast CT, followed by computed tomography angiography (CTA) as the first-line imaging modalities when traumatic aortic injury is suspected. Direct signs of aortic injury on CTA include pseudoaneurysm, focal contour abnormality, intimal flap, intramural hematoma, an abrupt change in aortic caliber, and contrast extravasation. Aortic pseudoaneurysms are most often caused by blunt or penetrating trauma that results in damage to the vessel wall, turbulent blood flow, and formation of a surrounding hematoma contained by a wall of products from the clotting cascade. This wall is weaker than those of a true aneurysm and will ultimately rupture over time if not repaired. Traumatic aortic pseudoaneurysms are preferably treated by thoracic endovascular aortic repair using a prosthetic stent graft. Here, we present a 44-yearold female with a history of homelessness, polysubstance use disorder, and HIV who presented to the emergency department after being found down. She reported being shot by a pellet gun, and physical examination revealed a penetrating left-sided chest wound that appeared to be several days old. A STAT CTA was obtained and revealed a hemopneumothorax and possible thoracic aortic pseudoaneurysm. A left-sided chest tube was placed and the patient underwent thoracic endovascular aortic repair through right femoral arterial access and tolerated the procedure well. The patient was placed on daily aspirin postoperatively and discharged on post-op day 5. |
| first_indexed | 2024-04-10T19:47:28Z |
| format | Article |
| id | doaj.art-7f40b5daf58e4fb1912228e39cd84e8c |
| institution | Directory Open Access Journal |
| issn | 1930-0433 |
| language | English |
| last_indexed | 2024-04-10T19:47:28Z |
| publishDate | 2023-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Radiology Case Reports |
| spelling | doaj.art-7f40b5daf58e4fb1912228e39cd84e8c2023-01-29T04:19:43ZengElsevierRadiology Case Reports1930-04332023-03-0118313681371Traumatic aortic injury from pellet gun: A case reportPaul Johnson, Bachelor of Science0Ryan Anderson, Bachelor of Science1Collin Gamble, MD2Eric van Bogaert, MD3Jonathan Joshi, MD4Corresponding author.; University of Louisville School of Medicine, 500 South Preston St, Louisville, KY 40202 USAUniversity of Louisville School of Medicine, 500 South Preston St, Louisville, KY 40202 USAUniversity of Louisville School of Medicine, 500 South Preston St, Louisville, KY 40202 USAUniversity of Louisville School of Medicine, 500 South Preston St, Louisville, KY 40202 USAUniversity of Louisville School of Medicine, 500 South Preston St, Louisville, KY 40202 USAAcute traumatic aortic injuries are of the most lethal sequelae of penetrating thoracic injuries and require rapid detection and management. The American College of Radiology currently recommends the use of noncontrast CT, followed by computed tomography angiography (CTA) as the first-line imaging modalities when traumatic aortic injury is suspected. Direct signs of aortic injury on CTA include pseudoaneurysm, focal contour abnormality, intimal flap, intramural hematoma, an abrupt change in aortic caliber, and contrast extravasation. Aortic pseudoaneurysms are most often caused by blunt or penetrating trauma that results in damage to the vessel wall, turbulent blood flow, and formation of a surrounding hematoma contained by a wall of products from the clotting cascade. This wall is weaker than those of a true aneurysm and will ultimately rupture over time if not repaired. Traumatic aortic pseudoaneurysms are preferably treated by thoracic endovascular aortic repair using a prosthetic stent graft. Here, we present a 44-yearold female with a history of homelessness, polysubstance use disorder, and HIV who presented to the emergency department after being found down. She reported being shot by a pellet gun, and physical examination revealed a penetrating left-sided chest wound that appeared to be several days old. A STAT CTA was obtained and revealed a hemopneumothorax and possible thoracic aortic pseudoaneurysm. A left-sided chest tube was placed and the patient underwent thoracic endovascular aortic repair through right femoral arterial access and tolerated the procedure well. The patient was placed on daily aspirin postoperatively and discharged on post-op day 5.http://www.sciencedirect.com/science/article/pii/S1930043322008925Traumatic aortic injuryEmergency radiologyPseudoaneurysmPellet gunHemopneumothoraxHemomediastinum |
| spellingShingle | Paul Johnson, Bachelor of Science Ryan Anderson, Bachelor of Science Collin Gamble, MD Eric van Bogaert, MD Jonathan Joshi, MD Traumatic aortic injury from pellet gun: A case report Radiology Case Reports Traumatic aortic injury Emergency radiology Pseudoaneurysm Pellet gun Hemopneumothorax Hemomediastinum |
| title | Traumatic aortic injury from pellet gun: A case report |
| title_full | Traumatic aortic injury from pellet gun: A case report |
| title_fullStr | Traumatic aortic injury from pellet gun: A case report |
| title_full_unstemmed | Traumatic aortic injury from pellet gun: A case report |
| title_short | Traumatic aortic injury from pellet gun: A case report |
| title_sort | traumatic aortic injury from pellet gun a case report |
| topic | Traumatic aortic injury Emergency radiology Pseudoaneurysm Pellet gun Hemopneumothorax Hemomediastinum |
| url | http://www.sciencedirect.com/science/article/pii/S1930043322008925 |
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