Delayed Traumatic Aortic Pseudoaneurysm Formation Causing Vertebral Body Erosion and Back Pain: Case Report and Literature Review

Cappuzzo, Justin M; Knudson, Kathleen; Sarin, Shawn; Babrowicz, Joseph C.; Cherrick, Abraham; Sherman, Jonathan H.

doi:10.1016/j.wneu.2017.11.035

Cited by 4 publications

(3 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The pathophysiology of traumatic pseudoaneurysm of the thoracic aorta caused by blunt chest trauma has been considered arterial wall damage from the intima towards the adventitia. On the other hand, the mechanism of traumatic thoracic aortic pseudoaneurysm caused by penetrating trauma from stabbing or bullet wounds is damage to the aorta from outside to inside [6] , [7] , [8] . Crossbow bolts have little kinetic energy, leading to fewer tissue injuries than those caused by bullets [9] , [10] .…”

Section: Discussionmentioning

confidence: 99%

The diagnosis of delayed expanding traumatic pseudoaneurysm of thoracic aorta caused by self-inflicted penetrating injury with crossbow bolt: A case report

Nakamura

Yamada

Naito

et al. 2021

International Journal of Surgery Case Reports

View full text Add to dashboard Cite

Introduction and importance Penetrating chest trauma caused by a crossbow bolt is very rare. Herein, we report a successfully treated patient who attempted suicide by directing a crossbow to the chest cavity and developed an expanding pseudoaneurysm of the thoracic aorta during eight-day follow up. Case presentation A 51-year-old male was admitted to the emergency department after firing a crossbow bolt twice into his left chest. At admission, the patient was hemodynamically stable and maintaining oxygenation. The bolt had already been removed from the body. Contrast-enhanced computed tomography (CT) revealed a cavity pseudoaneurysm 2.5 mm in size in the aortic arch. Three-dimensional reconstruction of the CT demonstrated wound tracts showing probable damage by the bolt. The patient was admitted to the emergency department for careful observation and transferred to the psychiatric ward on day two. Follow-up contrast-enhanced CT on day eight demonstrated rapid expansion of the pseudoaneurysm from 2.5 mm to 4.0 mm in size. We performed thoracic endovascular aortic repair (TEVAR) on day 13. The patient was uneventfully discharged on the 20th hospital day. Clinical discussion Emergency physicians should be aware that damage to the surrounding tissue may be accompanied by delayed expansion of an aortic pseudoaneurysm, even if the bolts do not cause direct aortic wall injury. Conclusion This case suggests that understanding the injury mechanism, confirming the tract of the bolts, and carefully exploring traumatic pseudoaneurysm can lead to a less invasive operation due to early detection.

show abstract

Section: Discussionmentioning

confidence: 99%

The diagnosis of delayed expanding traumatic pseudoaneurysm of thoracic aorta caused by self-inflicted penetrating injury with crossbow bolt: A case report

Nakamura

Yamada

Naito

et al. 2021

International Journal of Surgery Case Reports

View full text Add to dashboard Cite

show abstract

“…Iatrogenic and posttraumatic causes seem to be the more common types reported in the literature. 5 6 7 8 9 10 11 12 Liu et al recently published a literature review of iatrogenic vascular injuries postspinal surgery. They included 20 case reports totaling 26 patients, of which, 12 patients sustained a pseudoaneurysm during their clinical course.…”

Section: Discussionmentioning

confidence: 99%

“…Most of the cases were because of penetrating trauma (60%). 12 13 14 15 16 There are several other reports in the literature describing posttraumatic spinal pseudoaneurysms with most patients manifesting their symptoms within 1 year. 5 , 6 , 17 18 19 20 …”

Section: Discussionmentioning

confidence: 99%

Spinal Pseudoaneurysms Mimicking an Osteogenic Tumor: A Case Report

Alsalman

Aleissa²,

Alhandi³

et al. 2020

JAAOS Glob Res Rev

View full text Add to dashboard Cite

Aim: This study presents a rare case of pseudoaneurysm mimicking a tumor on the back, with no history of fever, trauma, or surgical intervention. In which no identifiable symptoms or warning signs were present. This pseudoaneurysm arises from intercostal arteries and segmental arteries. Both of which, to the limit of our knowledge, have not been discussed before. Method: This study was done using chart and literature review. We present a case of a 46-year-old man with a known case of left-sided intracranial hemorrhage due to hypertension and an old cerebrovascular accident. The patient has a positive history of hypertension, which could have attributed to the pseudoaneurysm; however, he has no history of vascular disease otherwise. The patient reports of back swelling and intermittent back pain for the past 3 years. On MRI, the mass showed a pulsating pattern around it. It also showed a layering effect because of different wall thicknesses and enhanced patterns, and the enhancement ratio was increased. In addition, it showed flow artifacts with T1 hyperintense areas because of associated thrombus and blood products. These changes noted on the MRI prompted the team to do a color Doppler study to confirm the presence of an aneurysm and if present, to do a CT angiography. The color Doppler showed a turbulent flow, that is, there was a bidirectional pulsatile flow which further confirms the presence of a pseudoaneurysm. Spine CT with contrast showed a right paraspinal lesion at the T9-T11 level. It had contrast enhancement and flow inside, consistent with a partially thrombosed aneurysm. The CT also showed evidence of bone remodeling in the adjacent thoracic vertebrae. The patient opted for spinal vascular emobilization and vascular sheath removal. The right and left intercostal arteries were selected at the level of left and right T4, left T8, bilateral T9, and bilateral T10. Conclusion: Differentiating between pseudoaneurysms and osteogenic tumors is essential to target later investigations accordingly. In addition, if pseudoaneurysms are left untreated, they could cause bony erosions of the vertebra, which lead to compression fractures. They can further compress the adjacent neurovasculature, which worsens the morbidity.

show abstract