(Circulation. 1998;97:932-933.)
© 1998 American Heart Association, Inc.
Images in Cardiovascular Medicine |
Late Sequelae of Traumatic Aortic Rupture
James W. Tam, MD;
Roy G. Masters, MD;
; Kwan L. Chan, MD
From the University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Correspondence to James W. Tam, MD, University of Ottawa Heart Institute, 1053 Carling Ave, Room H-210, Ottawa, Ontario, Canada K1Y 4E9.
A 57-year-old man had a
car accident resulting in multiple organ trauma, including severe head
injury and a tear of his aortic arch. The aortic tear was repaired with
a patch. A follow-up transesophageal echocardiogram
(TEE) with a multiplane probe demonstrated a localized bulge at the
site of the previous repair, indicating the development of a false
aneurysm (FA) with a distinct flap (arrow) separating the true
lumen (TL) from the false lumen (Fig 1
).
The schematic diagram (Fig 2) illustrates
the orientation of the imaging plane. The corresponding computerized
tomogram is illustrated in Fig 3.
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Figure 1.
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Figure 2.
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Figure 3.
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In view of the localized nature of the false aneurysm and the
presence of severe neurological impairment, the patient was managed
medically with close follow-up. Repeat TEE at 3 and 6 months showed no
progression of the false aneurysm. However, a routine TEE at 10
months showed that the aortic false aneurysm had ruptured
(arrow) and assumed a dumbbell shape, with thrombus (Th) lining much of
its wall (Fig 4). The schematic and the
corresponding computerized tomogram with three-dimensional
reconstruction are illustrated in Figs 5 and 6, respectively.
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Figure 4.
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Figure 5.
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Figure 6.
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Surgery was performed through a median sternotomy incision with
cardiopulmonary bypass and circulatory arrest. A 7-cm mass
consisting of fresh and old thrombus was found under the aortic arch. A
2x2-cm defect at the inferior surface of the aortic arch
was repaired with a Dacron patch. The patient made . . . [Full Text of this Article]
