Delayed aortic injury caused by sharp rib fracture

Kano, Masashi; Chikugo, Fumio; Fujimoto, Eiki

doi:10.1177/0218492312474903

Cited by 7 publications

(2 citation statements)

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“…Carter et al [4] repaired the impinging of the descending thoracic aorta wall by the fractured 5th rib during a motor vehicle collision on the 3rd post-trauma day. Kano et al [5] performed the replacement of an ascending thoracic aorta on the 11th post-trauma day (although it was a psychological problem of the patient). There was also a case in which the patient returned home from the emergency room on the injury date because there were no symptoms other than rib fracture; however, a delayed injury was found on the 4th post-trauma day when the patient visited the clinic due to pain [6].…”

Section: Discussionmentioning

confidence: 99%

A Treatment Case of Delayed Aortic Injury: The Patient with Posterior Rib Fracture

Park

Ryu

Cho

et al. 2014

Korean J Thorac Cardiovasc Surg

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A 66-year-old male patient arrived at the emergency room with a crush injury to his chest. Multiple rib fractures, hemothorax on both sides, left scapular fracture, liver laceration, and retroperitoneal hematoma were found upon the radiologic examination. After closed thoracostomy, the patient had been initially admitted to the intensive care unit, but he was transferred to the general ward on the next day. On the 4th post-trauma day, the patient complained of severe pain and there was bloody drainage through the chest tube. This case is an exploration with the consideration of the possibility of major bleeding and the subsequent repair of the descending thoracic aorta. This case is regarded as a case in which the aorta wall was damaged as the sharp margin of the fractured ribs caused continuous irritation.

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Section: Discussionmentioning

confidence: 99%

A Treatment Case of Delayed Aortic Injury: The Patient with Posterior Rib Fracture

Park

Ryu

Cho

et al. 2014

Korean J Thorac Cardiovasc Surg

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“…These BTAI cases typically involve the aortic isthmus ( 6 , 7 ). By contrast, RF-induced TAI predominantly affects the aorta adjacent to the broken ends of RFs or surrounded by free bone fragments ( 15 ). For TAI caused by post-fracture free bone fragments, some researchers propose treatment plans centered on the removal of free bone fragments ( 14 , 27 ).…”

Section: Discussionmentioning

confidence: 99%

The clinical characteristics and surgical treatment for delayed blunt thoracic aortic injury—a case series

Wang¹,

Wu²,

Guo³

et al. 2022

J Thorac Dis

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Background: Delayed thoracic aortic injury (DTAI) induced by left closed rib fractures (RFs) is a clinically rare blunt injury to the thoracic aorta with an insidious onset. DTAI is very prone to missed diagnosis due to the unreliability of using the initial post-injury computed tomography (CT) scan to explicitly detect any signs of an aortic injury, potentially leading to a fatal hemorrhage. Timely diagnosis and treatment are therefore key to preventing such deadly complications. With that said, not all cases of left RFs lead to delayed aortic injuries, so how can surgeons tell which cases are to be culled and focused on? Also, what kinds of treatment should be administered upon detection? Methods: A retrospective analysis was performed on the clinical data of DTAI cases induced by left closed RF that were admitted to our Hospital from June 2015 through June 2020. Injuries to the aortic tunica adventitia or the elastic layer were intraoperatively confirmed. CT scan findings, locations and numbers of RFs, as well as the choices of surgical procedure were reviewed postoperatively. In addition, a literature review was conducted to analyze characteristics shared by similar cases.Results: This study included 7 patients treated by our hospital and 8 reported in the literature. The broken ends of RFs causing aortic wall injury (including the tunica adventitia) were all found in the medial to the lateral erector spinae. All patients in our hospital received internal fixation for RFs and thoracoscopic removal of free bone fragments (if any). Concomitant injuries were managed either by simultaneous or staged surgery.Conclusions: For multiple left RFs with the broken ends located in the inside of the lateral erector spinae, the number of fractured ribs ≥4 and a smaller number of fractured ribs with multiple fractures in a single rib are important factors for DTAI. Active surgical intervention is recommended for patients with these important factors. The specific intervention is tailored to each patient's particular needs to eliminate the risk of developing life-threatening thoracic aortic injury (TAI) and rupture.

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Left fourth and sixth costovertebral dislocation abutting the aorta

et al. 2023

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While rib fractures are common in blunt thoracic trauma, dislocations of the costovertebral joints (CVJs) are extremely rare and typically involve the first, eleventh, or twelfth rib. We report a rare case of dislocation of the left fourth and sixth CVJs in a 36-year-old man who was run over by a car. The rib heads were displaced anteriorly, abutting the aorta. Additional injuries included bilateral hemopneumothoraces, pneumomediastinum, pulmonary contusions, grade 3 splenic injury, left adrenal hematoma, retroperitoneal hematoma, Morel-Lavallée lesions at bilateral hips, and multiple fractures, including at the ribs and pelvis. There was also a fracture of the fourth thoracic vertebral body, which was occult on initial CT, but seen on subsequent CTs. The CVJ dislocations were managed conservatively, without short-term complications. Prompt surgical intervention has been recommended in cases where sharp rib fracture fragments are displaced close to the aorta to prevent fatal aortic injuries. However, there is a literature gap on the management of rib heads that are dislocated against the aorta. Our experience suggests that conservative management may be acceptable in some of these cases. This case report aims to increase radiologists’ awareness of CVJ injuries, which are important for thoracic spine stability, and highlights the association between CVJ dislocations and spinal injuries.

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Delayed aortic injury caused by sharp rib fracture

Cited by 7 publications

References 0 publications

A Treatment Case of Delayed Aortic Injury: The Patient with Posterior Rib Fracture

A Treatment Case of Delayed Aortic Injury: The Patient with Posterior Rib Fracture

The clinical characteristics and surgical treatment for delayed blunt thoracic aortic injury—a case series

Left fourth and sixth costovertebral dislocation abutting the aorta

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