title: Atypical presentation of traumatic aortic injury.
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.
authors.affiliation: SingHealth Emergency Medicine Residency Program, Singapore Health Services, 167 Jalan Bukit Merah No. 17-10 Tower 5, Singapore 150167 ; Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608.
authors.forename: Andrew Fu Wah
authors.identifier: 0000-0003-4338-3876
authors.initials: AF
authors.lastname: Ho
authors.affiliation: SingHealth Emergency Medicine Residency Program, Singapore Health Services, 167 Jalan Bukit Merah No. 17-10 Tower 5, Singapore 150167.
authors.forename: Tallie Wei-Lin
authors.initials: TW
authors.lastname: Chua
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608.
authors.forename: Puneet
authors.initials: P
authors.lastname: Seth
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608.
authors.forename: Kenneth Boon Kiat
authors.initials: KB
authors.lastname: Tan
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608.
authors.forename: Sohil
authors.identifier: 0000-0002-4789-4326
authors.initials: S
authors.lastname: Pothiawala