A 36 yo male restrained driver was found unconscious in his car after a head-on high speed collision.  He was intubated on scene.  On arrival he had a normal BP with tachycardia and abrasions on his head and chest.  The tachycardia improves with blood products. FAST and chest xray are negative.  Sagittal view of CT with contrast is shown below.  What's the diagnosis?  Scroll down for answer.

Diagnosis:  Transection of the descending aorta

• Traumatic injury of the aorta is often fatal prior to arrival at the hospital. 
• Patients who survive usually have partial thickness tears with pseudoaneurysm formation (as was the case in the image above) rather than complete rupture.
• Patients with partial tears will often respond only transiently to resuscitative measures and blood products.
• Definitive treatment is surgical repair (open or endovascular).

References:

Ross, Christopher and Theresa Schwartz. “Cardiac Trauma.” Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e. Eds Judith E Tintinlli et al.  McGraw Hill, 2016.

Peitzman, A. “Thoracic Injury.” The Trauma Manual: Trauma and Acute Care Surgery. Lippincott Williams and Wilkins, 2013.