Pulmonary artery intimal injury associated with blunt trauma

Abstract

In recent years, intimal injuries to the aorta (minimal aortic injuries) have been diagnosed more frequently. We report the first case of pulmonary artery intimal injury in the setting of blunt trauma. We propose a number of theories regarding the pathogenesis, outcome, and treatment of pulmonary artery intimal injuries, drawing inferences from aortic intimal injuries. We conclude with a discussion on differentiating pulmonary artery intimal injury from the more common (but still rare) pulmonary artery dissection, using our case as an example.

Atypical Right Pulmonary Artery Dissection Complicating Severe Blunt Chest Trauma

“…Facing traumatic PAD, we opted for nonoperative management considering: (1) its anatomic presentation, (2) Disclosures: The authors certify that the work described has not been published previously, that it is not under consideration for publication elsewhere, that its submission is approved by all authors and explicitly by the responsible authorities where the work was carried out. If accepted, it will not be published elsewhere in the same form in English or in any other language, without the written consent of the copyright holder.…”

“…To the best of our knowledge, isolated traumatic PAD (without contemporary aortic isthmus rupture) has been mentioned as a cause of PAD but never thoroughly described in a surviving patient without surgical cure. 2 In this report, we describe a case of isolated, traumatic PAD complicating severe, blunt thoracic trauma whose originality lies both in its atypical anatomical presentation and its favorable outcome after nonoperative management.…”

Traumatic Blunt Rupture of Pulmonary Artery

“…The proposed mechanism of PA injury has been compared with that of aortic injury: shearing and bending forces on the artery, along with torsion, tension, and increased intravascular pressure as a result of interaction of the artery with adjacent skeletal structures. 1 Torsion and tension forces preferentially affect the intima, whereas bending and shearing forces tend to affect the adventitia. 1 Once PA injury has been identified, its management is controversial and variable without definitive guidelines due to its rarity.…”

“…1 Torsion and tension forces preferentially affect the intima, whereas bending and shearing forces tend to affect the adventitia. 1 Once PA injury has been identified, its management is controversial and variable without definitive guidelines due to its rarity. With recent widespread adoption of modern fast multidetector CT scan, a wider spectrum of vascular injuries that are not immediately lethal is now being detected.…”

Traumatic pulmonary artery injury: a review of the recent literature

“…However, unlike aortic dissection, PAD progresses rapidly and typically ruptures rather than developing a reentry site, which causes cardiogenic shock or sudden death, especially in non-traumatic cases with pulmonary hypertension [14] . Five major etiological groups can be identified: congenital malformation, infection or inflammation, acquired cardiac diseases, iatrogenic causes and trauma [15][16][17] . Traumatic PADs usually resolve or remain stable unless associated with pulmonary hypertension, in which case the risk of bleeding can be quite high [1,16] .…”