Ascending Aortic Arch Injury

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Carel

Great pictures.  unfortunately as Ken so correctly (and annoyingly) pointed
out, this is VOMIT.  The aorta is completely normal and this is mortion
artifact (not flow), despite this being a 64-slice acquisition.  Perhaps we
need to use the coronary imaging software when assessing the aortic arch?
Any comments from the radiologists?

Karim


On 09/01/07, J.C. Goslings <j.c.goslings at amc.uva.nl> wrote:
>
> Dear Karim,
> We recently treated 2 multiple injured patients with similar injuries
> in our center. After initial stabilization (ex fix) of pelvic and
> extremity injuries and 2-4 days of controlled hypotension on ICU, both
> were operated on cardiopulmonary bypass during which the intimal tear
> was repaired (see attached some low-resolution pictures).
> Both are doing fine with 6-12 months follow up.
> Good luck,
> kind regards,
> Carel Goslings and Kees Jan Ponsen,
> Trauma Unit dept Surgery
> Acadmic Medical Center Amsterdam
>
>
> ----- Original Message -----
> From: "Karim Brohi" <karim at trauma.org>
> To: <trauma-list at trauma.org>
> Sent: Monday, January 08, 2007 11:10 PM
> Subject: Ascending Aortic Arch Injury
>
>
> > Dear All
> >
> > 36yo male motocycle injury admitted 36 hours ago.
> > Haemodynamically normal.
> >
> > Injury complex:
> > ---------------
> > GCS15, No head injury
> > Fracture C7 through foramen transversarium (stable)
> > Bilateral first rib fractures & multiple left sided fractures.
> > Bilateral small haemothoraces and left lung contusion.
> > Open fracture left femur - externally fixated at present.
> >
> > Initial CT showed some upper mediastinal haematoma, thought initially to
> > be
> > related to the first rib fractures.
> > Repeat CT today shows dissection flap in ascending aorta.  Starts above
> > left
> > coronary.  No extension into neck vasculature (yet).
> > Not visible on initial CT.
> >
> > BP = 160 systolic -> controlled with labetalol.
> >
> > Now what?
> > Conservative management?
> > Stent?
> > Open repair? Technique?
> >
> > Karim
> >
> > --
> > trauma-list : TRAUMA.ORG
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> >
>
>
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>

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