Local Thrombus as an Isolated Sign of Traumatic Aortic Injury

Abstract

We report an unusual case of blunt traumatic aortic injury in which a mobile thrombus located at the isthmus was the only abnormality detected by transesophageal echocardiography. The case illustrates the high sensitivity of this diagnostic tool in aortic trauma and underscores the possibility of finding infrequent evidence of injury in subtle aortic lesions.

Traumatic Aortic Transection

“…Traumatic involvement of the aortic wall may vary from a discrete subintimal hemorrhage to complete laceration of all three layers of the aorta-intima, media, and adventitiaresulting in fatal intrathoracic hemorrhage. 2 The elasticity and integrity of the adventitia surrounding the ruptured intima and media is the factor that determines the patient's immediate survival at the time of the accident, by containing the expanding hematoma. A false aneurysm is formed in these patients at the site of rupture, the wall of which consists of adventitia and/or parietal pleura and other mediastinal structures.…”

Floating Thrombus of the Thoracic Aorta: A Rare Consequence of Blunt Trauma

“…5 Five patients were managed conservatively, with TEE-proven spontaneous disappearance of the thrombi. 4,6,7 Evaluation for blunt traumatic aortic injuries is important after high-speed deceleration collisions. TEE is highly sensitive and faster than CT scanning, but it is usually reserved for unstable patients.…”

“…The high probability of distal embolization and devastating visceral, spinal, and extremity ischemia in posttraumatic aortic thrombosis favors emergency surgery to treat the injury and prevent its complications. 5,6,9 Aortotomy and resection of the intimal flap might be adequate if the injury is localized, the flap small, and the overlying aortic layers intact. 5 Our patient's periaortic hematoma indicated a transmural aortic injury, making aortic resection and grafting the only safe approach.…”

Transesophageal Echocardiography and Therapeutic Management of Patients Sustaining Blunt Aortic Injuries

“…These results are consistent with previous reports in which mural thrombi and intimal tears frequently healed spontaneously or remained stable over time. 2,[17][18][19]32,33 Because of the unknown natural history of minor BAI, long-term follow-up of these patients should be considered until total healing is observed.…”