CTICasesTraumatic Aortic Injury of the Ascending Aorta (Atypical Location)
Imaging findings
A young pedestrian struck by a car had a chest radiograph with a poorly defined aortic knob, loss of the aortopulmonary window, possible periaortic hematoma, and rightward tracheal deviation. CT showed a mediastinal hematoma and a focal traumatic aortic injury involving more than 180 degrees of the aortic wall, located in the tubular ascending aorta a few centimeters above the sinotubular junction, an atypical site compared with the more common root, isthmus, or diaphragmatic locations. Because of other severe injuries, surgery was delayed about a week; a nearly circumferential tear at that same location was confirmed intraoperatively, and interim follow-up CT was unchanged.
Key takeaways
Traumatic aortic injury classically occurs at the aortic root, isthmus, or diaphragmatic hiatus, but can rarely occur in the tubular ascending aorta just above the sinotubular junction. Recognizing the radiographic and CT signs of mediastinal hemorrhage in this atypical location matters because these injuries can remain stable for days and, if not immediately catastrophic, may be observed until more urgent injuries are addressed.
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