CTICasesGrade IV Blunt Aortic Injury with Active Extravasation
Imaging findings
Chest radiograph reveals a wide mediastinum, subcutaneous emphysema, bilateral pulmonary opacities, and chest tubes. Non-contrast chest CT shows a high-attenuation mediastinal hematoma measuring greater than 15 millimeters in thickness, which displaces the trachea and central venous catheter to the right. Contrast-enhanced CT confirms a severe circumferential blunt aortic injury (aortic transection) at the isthmus with a multi-lobulated pseudoaneurysm. There is a focal jet of contrast material extending beyond the pseudoaneurysm wall into the mediastinal hematoma, representing active extravasation.
Key takeaways
Blunt aortic injury is a life-threatening trauma pathology that ranges in severity from intimal tears to free rupture. A grade III injury involves a pseudoaneurysm, while a grade IV injury is defined by free rupture with active contrast extravasation into the mediastinum, as demonstrated in this case. Key imaging signs of high-risk aortic injury that warrant urgent surgical or endovascular intervention include a large mediastinal hematoma thicker than 15 millimeters, mass effect on the trachea, and a visible jet of extravasated contrast.
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