A 48 year old male was  the restrained driver in a high-speed motor vehicle collision with a tree. He presents to the ED with multiple pain complaints, he is awake on arrival to the ED, mildly tachycardic and BP104/53. He goes for CT scan.  What’s the diagnosis?  (scroll down for answer)

Answer: Thoracic aortic transection with surrounding mediastinal hematoma

• Imaging may reveal a widened mediastinum, loss of the normal aortic contour, depression of the left main bronchus, a left apical pleural cap, and or deviation of the trachea or NG tube to the right
• The most common lead off point in traumatic cases is the aortic isthmus, near the ligamentum arteriosum at the proximal portion of the descending thoracic aorta
• The majority of patients die at the scene of the accident
• In addition to trauma surgery, emergent consultation of both cardiothoracic surgery and interventional radiology may be required - repair involves surgery or stent grafting
• Click here for more images and information on thoracic aortic injuries.