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Silent dissecting aortic aneurysm without longitudinal dissection in a polytraumatized patient

Mustafa Yilmaz, Metin Demircin, Gursel Leblebicioglu, Murat Guvener, Halil Ybrahim Ucar, Riza Dogan, Ilhan Pasaoglu

CaseRepClinPractRev 2003; 4(3):246-248

ID: 450678

Background: Blunt chest trauma remains a rare cause of acute aortic dissection. In this paper we report a polytraumatized patient with multiple fractures and late silent appearing aortic aneurysm.
Case Report: A 38 year-old man, involved in a motor vehicle accident was brought to the emergency unit. Chest X-ray examination revealed hemo-pneumo thorax on left site He had mid diaphyseal fractures of his left radius and ulna and distal one-third fracture of his left femur. Chest tube was inserted. Ten hours following admission open reduction and internal fixation were applied Chest X-ray examination at the 15th day revealed mediastinal enlargement. DSA revealed thoracic aortic aneurysm just distal to the left subclavian artery. Left posterolateral
thoracotomy was used. There was circumferential intimal tear and the aneurysm sac was composed of only
adventitial layer. Aorta was reconstructed with 22 mm tubular graft. His postoperative course was uneventful
and he was discharged on the 29th day following the accident.
Conclusions: Traumatic aortic dissecting aneurysm without longitudinal dissection is an uncommon. It may
develop a couple of days following the injury. There is no similar case of silent circumferential aortic aneurysm which developed two weeks after the trauma, in the literature Operative repair of traumatic aortic dissecting aneurysm is the treatment of choice although it has a high mortality rate.

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