Aortic Impingement in Displaced Traumatic Spine Fracture with Complete Spinal Cord Transection: A Case Report

Aortic impingement associated with traumatic thoracic spinal fractures is a rare and potentially lethal complication that creates management challenges in an already complex clinical problem. Traumatic aortic injury is one of the leading causes of death in blunt trauma. Magerl divided thoracic and lumbar fractures into 3 categories; the primary focus of this report, type C fractures, describes rotational injury and is one of the less common types, especially associated with aortic impingement as such. In this case, a young man was admitted following a near-fatal fall resulting in blunt force trauma to the midthoracic region. Emergency CT revealed a type C complete transection at the level of T11 and a grade I aortic injury. Definitive fixation of the spinal injury was delayed in favor of preventing further vascular injury by prioritizing the securing of hemodynamic stability. In traumatic thoracolumbar injuries, blunt traumatic aortic injury is often managed conservatively. However, blunt thoracic aortic injury is one of the leading causes of death from trauma, and each case requires its own case-by-case multidisciplinary management. In this occasion, management of the vascular insult was paramount to ensuring patient survival and favorable outcome.

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History of posterior thoracic instrumentation

Neurosurgical FOCUS ◽

10.3171/foc.2004.16.1.12 ◽

2004 ◽

Vol 16 (1) ◽

pp. 1-4 ◽

Cited By ~ 10

Author(s):

Harshpal Singh ◽

Scott Y. Rahimi ◽

David J. Yeh ◽

David Floyd

Keyword(s):

Multiple Stressors ◽

Spinal Injury ◽

Posterior Instrumentation ◽

Spinal Instrumentation ◽

Spinal Column ◽

Spinal Fractures ◽

Thoracic Spinal ◽

History Of ◽

Central Meaning ◽

Historical Treatment

The term “backbone” appears in many expressions used in modern day society. In any scenario, it has one central meaning: stability. Best defined as a foundation that is able to sustain multiple stressors without adversely affecting integrity, the commonly and appropriately termed backbone of humans is the spinal column. As the central focus of stability in our species, the spine is subject to a great degree of trauma and mechanical forces. A variety of methods have been developed throughout history in the treatment of spinal column injury. Initial treatment involved the use of simple traction devices for the reduction of spinal fractures; these have evolved to include the current insertion of spinal instrumentation. The authors review the historical treatment and development of posterior instrumentation for thoracic spinal injury.

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MR Imaging Findings of Traumatic Thoracic Aortic Injury

Journal of the Korean Radiological Society ◽

10.3348/jkrs.2002.46.4.351 ◽

2002 ◽

Vol 46 (4) ◽

pp. 351

Author(s):

Min Jee Sohn ◽

Joon Beon Seo ◽

Hyun Woo Koo ◽

Han Na Nho ◽

Meong Gun Song ◽

...

Keyword(s):

Mr Imaging ◽

Aortic Injury ◽

Imaging Findings ◽

Thoracic Aortic Injury

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Iatrogenic thoracic aortic injury in esophagectomy – a case report and literature review

Perspectives in Surgery ◽

10.33699/pis.2019.98.6.256-259 ◽

2019 ◽

Vol 98 (6) ◽

pp. 256-259

Keyword(s):

Case Report ◽

Minimally Invasive ◽

Thoracic Aorta ◽

Aortic Rupture ◽

Hypovolemic Shock ◽

Left Lung ◽

Aortic Injury ◽

Thoracoscopic Esophagectomy ◽

Neoadjuvant Radiochemotherapy ◽

Thoracic Aortic Injury

Introduction: This case report describes bleeding from an iatrogenic thoracic aortic injury in minimally invasive thoracoscopic esophagectomy. Case report: A 53-year-old man underwent neoadjuvant radiochemotherapy for adenocarcinoma of the esophagus with positive lymph nodes. PET/CT showed only a partial response after neoadjuvant therapy. Minimally invasive thoracoscopic esophagectomy in the semi-prone position with selective intuba- tion of the left lung was performed. However, massive bleeding from the thoracic aorta during separation of the tumor resulted in conversion from minimally invasive to conventional right thoracotomy. The bleeding was caused by a five millimeter rupture of the thoracic aorta. The thoracic aortic rupture was treated by suture with a gore prosthesis in collaboration with a vascular surgeon. Esophagestomy was not completed due to hypovolemic shock. Hybrid transhiatal esophagectomy was performed on the seventh day after the primary operation. Definitive histological examination showed T3N3M0 adenocarcinoma. Conclusion: Esophagectomy for cancer of the esophagus is one of the most difficult operations in general surgery in which surgical bleeding from the surrounding structures cannot be excluded. Aortic hemorrhage is hemodynamically significant in all cases and requires urgent surgical treatment.

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Two uncommon cases of thoracic aortic injury caused by rib fractures

Journal of Thoracic Disease ◽

10.21037/jtd.2019.03.45 ◽

2019 ◽

Vol 11 (S8) ◽

pp. S1113-S1118

Author(s):

Hao Xie ◽

Shaonan Ning ◽

Nan Li ◽

Lei Song ◽

Yanbin Wang ◽

...

Keyword(s):

Aortic Injury ◽

Rib Fractures ◽

Thoracic Aortic Injury

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Blunt Traumatic Aortic Injury: 10-Year Single-Center Experience

Aorta ◽

10.1055/s-0040-1715608 ◽

2021 ◽

Author(s):

Ahmet Can Topcu ◽

Kamile Ozeren-Topcu ◽

Ahmet Bolukcu ◽

Sinan Sahin ◽

Avni U. Seyhan ◽

...

Keyword(s):

Thoracic Aorta ◽

Subclavian Artery ◽

Open Repair ◽

Left Subclavian Artery ◽

Aortic Injury ◽

Blunt Thoracic Aortic Injury ◽

Phone Calls ◽

Primary Treatment Modality ◽

Thoracic Aortic Injury

Abstract Objective In blunt trauma patients, injury of the thoracic aorta is the second most common cause of death after head injury. In recent years, thoracic endovascular aortic repair (TEVAR) has largely replaced open repair as the primary treatment modality, and delayed repair of stable aortic injuries has been shown to improve mortality. In light of these major advancements, we present a 10-year institutional experience from a tertiary cardiovascular surgery center. Methods Records of patients who underwent endovascular or open repair of the ascending, arch or descending thoracic aorta between January 2009 and December 2018 were retrospectively analyzed. Patients without blunt traumatic etiology were excluded. Perioperative data were retrospectively collected from patient charts. Long-term follow-up was performed via data from follow-up visits and phone calls. Results A total of 1,667 patients underwent 1,740 thoracic aortic procedures (172 TEVAR and 1,568 open repair). There were 13 patients (12 males) with a diagnosis of blunt thoracic aortic injury. Mean patient age was 43.6 years (range, 16–80 years). Ten (77%) patients underwent TEVAR, two (15.4%) underwent open repair, and one (7.7%) was treated nonoperatively. Procedure-related stroke was observed in one (7.7%) case. Procedure-related paraplegia did not occur in any patients. Left subclavian artery origin was covered in seven patients. None developed arm ischemia. Hospital survivors were followed-up for an average of 60.2 months (range, 4–115 months) without any late mortality, endoleak, stent migration, arm ischemia, or reintervention. Conclusion Blunt thoracic aortic injury is a rare but highly fatal condition. TEVAR offers good early and midterm results. Left subclavian artery coverage can be performed without major complications.

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