Acute traumatic injury of the distal descending aorta associated with thoracic spine injury

Murakami, Ryusuke; Tajima, Hiroyuki; Ichikawa, Kazuo; Kobayashi, Yuko; Sugizaki, Kenichi; Yamamoto, Kōichi; Kurokawa, Akira; Kumazaki, Tatsuo

doi:10.1007/s003300050339

Cited by 15 publications

(10 citation statements)

References 13 publications

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“…These studies also explain the predilection for concomitant injuries to the branch vessels (20,21). Direct injury of the thoracic aorta may also occur due to penetrating injury from rib and thoracic vertebral body fractures (24,25).…”

Section: Essentials ⅲmentioning

confidence: 81%

“…The distal descending aorta is tethered to the adjacent spine by the crux of the diaphragm and therefore injuries here are thought to occur as a result of shear forces applied at this location. Injuries to this segment of the thoracic aorta can be associated with diaphragm injury in 10% of cases and with adjacent compression fractures of the thoracic spine (25,67). Imaging pitfalls.-Diagnostic pitfalls can be divided into two categories, anatomic and technical.…”

Section: Multidetector Ctmentioning

confidence: 99%

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Acute Traumatic Aortic Injury: Imaging Evaluation and Management

et al. 2008

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Despite recent advances in prehospital care, multidetector computed tomographic (CT) technology, and rapid definitive therapy, trauma to the aorta continues to be a substantial source of morbidity and mortality in patients with blunt trauma. The imaging evaluation of acute aortic injuries has undergone radical change over the past decade, mostly due to the advent of multidetector CT. Regardless of recent technologic advances, imaging of the aorta in the trauma setting remains a multimodality imaging practice, and thus broad knowledge by the radiologist is essential. Likewise, the therapy for acute aortic injuries has changed substantially. Though open surgical repair continues to be the mainstay of therapy, percutaneous endovascular repair is becoming commonplace in many trauma centers. Here, the historical and current status of imaging and therapy of acute traumatic aortic injuries will be reviewed.

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Section: Essentials ⅲmentioning

confidence: 81%

Section: Multidetector Ctmentioning

confidence: 99%

Acute Traumatic Aortic Injury: Imaging Evaluation and Management

et al. 2008

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“…Mechanical ruptures of the aorta can also be caused by postoperative changes in the posture, for example an associated rupture of the aorta after surgery of an ankylosis spondylitis as a mechanical complication after set up [7]. Traumatic damages of the aorta occur often at dull high velocity traumas of the thorax with fatal consequences [8,9].…”

Section: Discussionmentioning

confidence: 99%

Late Erosion of the Aorta after Dorsal-Ventral Care of a L1 Fracture with Prominent Chip Position

Langen

Kühling

Grüber

et al. 2007

Eur J Trauma Emerg Surg

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Due to results of biomechanical examinations, the dorsal-ventral stabilization of thoracic spine and lumbar spine fractures is an acknowledged method. Different possible complications - among them life-threatening ones- of this method have been published already. We will discuss a complex case wherein an erosion of the aorta led to an acute hemorrhagic shock symptomatology 98 days after primary dorsal-ventral care. Retrospectively, an already close contact of the aorta to the pressed-in chip could be identified as the reason in a postoperative CT control after ventral care. However, due to a postoperative course of infection the chip position has been accepted as such and not been changed. But this difficult and complex etiopatology has shown that chip and respectively material positions with contact to adjacent soft tissue structure are not acceptable.

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“…In spite of the absence of further displacement during the clinical course over 2 months, those concerns were considered an indication for anterior surgery. Concomitant vascular injury following injuries to the thoracic spine are a well-recognized occurrence [15,21,23]. In a retrospective hospital study concerning severely injured patients, the occurrence of traumatic aortic rupture (TAR) was 5.5% in patients with upper thoracic spine fractures, and the mortality rate was 100% among them (five patients) [22].…”

Section: Discussionmentioning

confidence: 99%

Traumatic total axial reversal of the thoracic vertebral body

Jacquot

Signoret

Feron

1999

European Spine Journal

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IntroductionNumerous vertebral fracture patterns have been reported in the literature in the thoracic and thoracolumbar spine. These have been classified in different systems that take into account involvement of bone and soft tissue [1,9], injuries in different compartments such as the "three-column concept" of Denis [3], and displacement in the three dimensions [5,12]. The occurrence of some degree of rotation in the overall fracture pattern is a well-recognized factor of complications such as instability and neurological involvement. However, some fracture patterns still do not fit into any classification scheme [12]. We present the case of a patient who sustained severe trauma to the back that resulted in a very unusual and not previously reported pattern of injury. Unsuspected vascular complication resulted in severe evolution with fatal outcome. Case reportThe patient was a 52-year-old man who suffered a work-related accident in which he was struck from behind by a concrete tank that fell from a construction crane. He was admitted to the hospital as an emergency, with T7 complete paraplegia and in subacute respiratory distress. Chest radiographs showed bilateral haemothorax and anterolateral flail chest. Emergency lateral thoracic spine radiograph showed a 6-mm retrolisthesis of the T5 vertebral body over the T6 vertebra and an 11-mm retrolisthesis of T6 over T7 (Fig. 1). The anteroposterior (AP) view was rated normal with good alignment (Fig. 2). Only CT examination provided the basis for the diagnosis. CT scans revealed fractures of the T4, T5 and T6 pedicles, and showed that the T6 vertebral body was in a completely rotated position, with the posterior wall and broken pedicles being actually anterior, whereas the anterior aspect of the vertebral body was posterior, close to the dura (Figs. 3, 4) This suggested that the T6 vertebral body had undergone a complete 180°rotation around a vertical axis at the time of injury (Figs. 5, 6). Significant widening of the gap between the T6 and T7 facet joint was also present, with T6 posterior elements markedly displaced posteriorly, but the whole segment remained in gross alignment.In the intensive care unit, the patient remained a complete paraplegic. The clinical course was characterised by marked respiratory distress, Gram-negative pulmonary infection and severe urinary infection. A tracheostomy was needed on the 6th day, and all other surgery had to be delayed. The general status improved slowly in the intensive care unit, with chest drainage and antibiotics. MR imaging could be performed only after 1 month. It showed severe injury to the spinal cord and abnormal signal of the T6 and anterior part of T5 vertebral bodies (Fig. 7). No vascular abnormalities concerning the great vessels were suspected on the MR or CT studies. The segmental arteries at the level of the fractured vertebra could not be seen on these examinations.Instability due to rotation and the disruption of soft tissues was considered an indication for anterior surgery. The operation was Abstrac...

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Acute traumatic injury of the distal descending aorta associated with thoracic spine injury

Cited by 15 publications

References 13 publications

Acute Traumatic Aortic Injury: Imaging Evaluation and Management

Acute Traumatic Aortic Injury: Imaging Evaluation and Management

Late Erosion of the Aorta after Dorsal-Ventral Care of a L1 Fracture with Prominent Chip Position

Traumatic total axial reversal of the thoracic vertebral body

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