Chronic Thoracic Aortic Aneurysm Presenting 29 Years following Trauma

Abstract

Blunt, nonpenetrating injuries of the thoracic aorta are uncommon and associated with a high mortality rate within the first hour. Aortic injury is missed in 1-2% of patients that survive to hospital, and a chronic thoracic aortic aneurysm may subsequently form. We present a case in which a chronic thoracic aortic aneurysm was diagnosed 29 years following a significant motor vehicle accident. We discuss the epidemiology, presentation, and management of this uncommon consequence of blunt, nonpenetrating aortic injury. Our case illustrates an important clinical lesson; a past medical history of trauma should not be overlooked at any patient assessment.

Figure 1

Chest X-ray: lung fields appear clear and there is no evidence of cardiomegaly. A smooth enlargement of the left hilum, initially felt to represent an enlarged pulmonary artery, can be seen.

Figure 2

Coronal computed tomography imaging. A 39 mm × 54 mm × 32 mm saccular aneurysm can be seen arising from the aortic isthmus.

Figure 3

Transverse computed tomography imaging. Dense calcifications can be seen within the aneurysm wall.

Figure 4

3D reconstruction demonstrating the saccular aneurysm arising from the aortic isthmus.