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BACKGROUND
A 30-year-old man is brought to the emergency department
by ambulance after a high-velocity motor vehicle
accident. The patient was the restrained driver when his
car skidded out of control on an icy road and hit a tree
head-on at approximately 60 mph. Emergency personnel
report that the patient was conscious at the scene but
unable to get out of his car because the steering column
had collapsed, pinning him into his seat. He required
extrication from his vehicle.
In the ambulance and on arrival to the emergency
department, the patient's only complaint is severe chest
pain that radiates to his back. He has also
progressively developed shortness of breath.
On physical examination, the patient is conscious and in
moderate distress secondary to the pain in his chest.
His heart rate is 84 beats per minute, and his initial
blood pressure is 124/67 mm Hg. His respiratory rate is
16 breaths per minute, and his temperature is 98.7°F. He
has superficial abrasions on his face and scalp, with
intact dentition. His pupils are both 4 mm and reactive.
He can move his eyes in all directions on command.
Abrasions and bruising are observed over the sternum,
which is tender to palpation. The patient's lungs are
clear, with equal breath sounds on both sides. Palpation
reveals no tenderness over the ribs or abdomen. He has
no evidence of extremity injury and can move his arms
and legs without difficulty.
An anteroposterior (AP) chest radiograph was obtained in
the trauma room (see Image 1). Following this, a CT of
the chest and an arteriogram were obtained (see Images
2-3).
What is the diagnosis? |
Hint
Look at the proximal descending aorta on the arteriogram
and CT scan. |
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Authors:
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Jeremy Logan, MD, University
of New Mexico Hospital Residency, Department of Radiology, Albuquerque,
New Mexico
Gautam Dehadrai, MD, Staff Physician, Department of Radiology, Veterans
Administration Hospital, Albuquerque, New Mexico
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eMedicine Editor:
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Rick Kulkarni, MD, Attending Physician, Director of Informatics,
Department of Emergency Medicine, Olive View - UCLA Medical Center,
Assistant Professor of Medicine, David Geffen School of Medicine at UCLA |
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