Traumatic Abdominal Aortic Dissection, a Rare Near-Missed Diagnosis: A Case Report and Literature Review

Case Report

Austin J Clin Case Rep. 2023; 10(5): 1290.

Traumatic Abdominal Aortic Dissection, a Rare Near-Missed Diagnosis: A Case Report and Literature Review

Chadi Rahmani1,2*; Yassine Kherchttou1,2; Manal Rhezali1,2; Taoufik Abou Elhassan1,2; Hicham Nejmi1,2

1Anesthesiology, Intensive care and Emergency Department, University Hospital Mohammed VI of Marrakech, Morocco

2Faculty of Medicine and Pharmacy of Marrakech, Cadi Ayyad University, Morocco

*Corresponding author: Chadi Rahmani Anesthesiology, Intensive Care and Emergency department, University Hospital Mohammed VI of Marrakech, Morocco. Email: chadi.rahmani@gmail.com

Received: May 26, 2023 Accepted: June 21, 2023 Published: June 28, 2023

Abstract

Acute traumatic dissection of the abdominal aorta due to blunt trauma is a rare and life-threatening condition, often resulting in death. Immediate diagnosis is critical for successful treatment and improved prognosis. In this case presentation, a 60-year-old man was found unconscious after a road accident and was diagnosed with aortic dissection that went unnoticed initially due to associated severe injuries. CT-scan and ultrasound examination confirmed the diagnosis of abdominal aortic dissection. This case highlights the importance of a high index of suspicion when certain signs are present, such as seat-belt sign, bowel injury, or spinal injury. CT-scan is an accurate diagnostic tool, and close imaging follow-up is necessary as delayed complications can occur. Nonoperative and endovascular management is often chosen.

Keywords: Aortic injury; Abdominal aorta; Emergency; High-energy trauma; Computed tomography scan

Abbreviations: ICU: Intensive Care Unit; GCS: Glasgow Coma Scale; eFAST: Extended Focused Assessment with Sonography in Trauma; CT-Scan: Computed Tomography Scan; AAST: American Association for the Surgery of Trauma; TAAI: Traumatic Abdominal Aortic Injury; MRI: Magnetic Resonance Imaging

Introduction

Acute traumatic dissection of the abdominal aorta secondary to blunt trauma is a rare and life-threatening injury. These lesions may initially go unnoticed due to the simultaneous presence of other critical and more visible lesions. They are typically brought on by high-energy trauma that results in direct or indirect forces on the abdomen that are frequently associated with rapid deceleration [1]. Non-penetrating road crashes are responsible for about 90% of acute traumatic lesions. Following physical trauma, disruption of the intima, subintimal hemorrhage, and thrombosis are occasionally. Before medical assistance can be provided, the majority of acute traumatic injuries to the abdominal aorta are usually fatal. If the diagnosis can be made immediately, surgical treatment may be indicated.

We present a rare and life-threatening aortic dissection after blunt abdominal trauma, which was initially not detected due to technical insufficiency. This case highlights the importance of comprehending the nature of the trauma, its subsequent injuries, and the need for a body Computed Tomography Scan (CT-scan) with intravenous contrast enhancement in patients who have high-energy impacts.

Case Presentation

Patient Information

We present the case of a 60-year-old man, with no known (initially) identity or medical history, who was found unconscious in a likely traumatic context on the highway and transferred to the ICU by ambulance, the exact mechanism of the trauma was not known.

Clinical Findings

The primary assessment showed an unconscious patient with GCS of 3 with miosis progressed to anisocoria, parietal scalp hematoma and macroscopic hematuria, however the present patient was hemodynamically and respiratory stable, there was no auscultation abnormality. Abdominal clinical exam was normal, no hematoma was noted, and the examination of limbs was also normal with a normal distal pulse.

Diagnostic Assessment

The eFast ultrasound performed showed no abnormalities. After initial conditioning, a body CT-scan was performed, revealing an acute subdural hematoma with a hypodense right frontal collection associated with subarachnoid and intraventricular hemorrhage (Figure 1). The abdominal CT-scan showed a perirenal hematoma associated with a 3cm lower polar kidney fracture, classified as AAST grade III, with an image of abdominal aortic thrombus (Figure 2).