CTICasesPenetrating Aortic Injury from a Nail Gun
Imaging findings
Frontal chest radiograph reveals a metallic nail projecting over the superior mediastinum. Chest CT demonstrates the nail penetrating directly through the sternum and traversing the anterior mediastinum into the proximal descending thoracic aorta. There is surrounding mediastinal hemorrhage and stranding but no active extravasation of arterial contrast.
Key takeaways
Penetrating thoracic trauma from nail guns can cause catastrophic injuries to the heart and great vessels. Patients can sometimes present with surprisingly mild chest discomfort despite direct aortic penetration, as the nail itself can temporarily tamponade active extravasation, allowing for stable transport to emergent surgical repair.
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