Abstract:

Acute traumatic aortic rupture is associated with extremely high mortality and requires urgent diagnosis and treatment.

Materials and methods: patient P, 33 years 28.12.2013, fall from a height of 5 floors. On the day of admittion to hospital he was hospitalized to the reanimation department with a diagnosis of «multiple trauma, traumatic shock». For nearest hours after admission MSCT of head, neck, chest organs, abdomen and pelvis were performed.

Results: in series of images of the head and neck revealed multiple fractures of facial bones anc skull base, hemo-sinus.

MSCT chest without contrast enhancement: expanding boundaries revealed the presence of the upper mediastinum content density of 65 Hounsfield units (Ed.N) around the arch and descending aorta, in tissues of the posterior mediastinum. Volume of about 35 cm3 - in the pericardial cavity, ribs on the left with a displacement of fragments, left-sided hemothorax (260 cm3). During examination of abdomen and pelvis in the native phase: in subhepatic space in the liver portal, volume of about 50 cm3 with density of blood multiple fractures of the pelvis. CT with contrast-enhanced bolus revealed uneven expansion in the thoracic aorta isthmus length of 60 mm, with the presence at this level of linear structures intraluminal wall surface (wall laceration), and a narrow zone of extravasation of the contrast agent on the inner contour of the aorta. At the lever portal detected delimited zone of active extravasation of contrast material as a result of breaking its proper hepatic artery which is essentially as a thrombosis of pseudoaneurysm with zone of thrombosis around the periphery and subcapsular rupture of the left lobe of the liver

Ultrasound examination - left-sided hydrothorax, echo signs of free fluid in the abdominal cavity, liver hematoma in the area of the portal, diffuse changes in kidneys («shock» kidney).

Patient underwent primary surgical dressing of face wounds, osteosynthesis of right femur with external fixation device (EFD). Endoprothesis of descending thoracic aorta was performed 29.12.2013. After implantation of the prothesis, celiacography was performed, in which in liver portal, in the place of proper hepatic artery division to the right and left hepatic artery - large-size false aneurysm was revealed.

CT scanning, performed on the 5th day after aortic replacement: there are signs of segmental atelectasis of the lower lobe of the left lung, minimum infiltrative changes in fiber anterior mediastinum, hematoma of the posterior mediastinum (31 cm3. Previously was 191 cm3), and hemopericardium (15 cm3 compared with 35 cm3)

In the process of dynamic observation, it was found that up to 30 days, false aneurysm of proper hepatic artery increased in size, in this regard, the patient was operated on 24.01.14.

Follow-up CT scan with contrast enhancement: branches of the hepatic artery are well visualized, artery aneurysm is not defined

12.02.14, was the dismantling of EFD and manufactured fixation of the right femur pin. After 65 days after the injury and the start of treatment the patient was discharged under the supervision of the surgeon and cardiologist in the community.

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