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Sat May 3 02:34:00 BST 2008

There is hemorrhage in the mediastinum on both the CT and the CXR. I think this is due to an injury? of the origin of the left common carotid artery. However the descending aorta is not shown on these images. 

I would perform a formal arteriogram of the aortic arch unless the entire CT clearly visualizes all potential injuries both axially and with reformations of the cTA. 

I am concerned about all the facial injury and the possibility of BCVI but would be quite hesitant to do the necessary selective carotid arteriography unless the arch study clearly excluded my suspected left carotid injury.

If there is an isolated injury of the left common carotid artery anatomically amenable to a stent graft, this would be a good option that i would favor. If the arch or descending aorta is injured in addition to the LCCA, I would be happy not to have to make that decision.

sal

-----Original Message-----
From: daniel simon <danielsimonster at gmail.com>
To: trauma-list at trauma.org
Sent: Thu, 1 May 2008 11:29 am
Subject: unusual case

43 year old motorcycle crash victim , on scene intubation for GCS of 5. On
admission intubated and ventilated, B.P 130/80 P 82 sat 100% , GCS 7 (T) .
PE: skin lacerations and  central hematoma anterior neck - zone 1.
Head CT - SAH, Frontal contusions,small Frontal SDH, many skull fractures.
C-spine:  fracture of C1
Chest XR and relevant cuts from the chest  CTA included.
Abdominal CT normal
What would you do now?

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