Fall leading to aortic injury Article Swipe
YOU?
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· 2024
· Open Access
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· DOI: https://doi.org/10.1002/emp2.13097
· OA: W4391610781
A middle-aged male with an unknown past medical history presented to the emergency department (ED) by ambulance after falling 4 feet off a step ladder. On arrival, the patient appeared uncomfortable and was complaining of back pain. He was in atrial fibrillation at 130 beats per minute and had a blood pressure of 100/69 mmHg. His primary survey was intact and secondary survey was notable for lumbar paraspinal tenderness to palpation, with no midline bony tenderness or step-offs. His Focused Assessment with Sonography in Trauma examination was negative. Computed tomography (CT) scans were then performed (Figures 1 and 2). This case describes a minor fall resulting in vertebral fractures and associated full-thickness laceration of the descending aorta. After CT, the patient was transported emergently to the operating room (OR) for aortic repair. In the OR, his aorta was found to be lacerated at the level of the vertebral fractures with uncontrollable retroperitoneal bleeding that was ultimately fatal. Aortic injuries of this severity often do not survive to the ED, as extensive blood loss results in rapid exsanguination.1, 2 Traumatic aortic injuries can arise from either penetrating or blunt trauma.3 Blunt aortic Injuries are often a result of high-impact deceleration events, such as motor vehicle collisions causing sudden mechanical shearing forces that rupture the aorta.4, 5 Here, we present a case of blunt traumatic aortic rupture instead secondary to vertebral injuries from a minor fall. Prior literature has described cases of sub-diaphragmatic aortic injuries associated with thoraco-lumbar fractures.6-9 Interestingly, prior reports include patients with ankylosing spondylitis, as these patients are at increased risk of vertebral fractures.10-12 Notably, additional CT findings in this patient included partial fusion of the right sacroiliac joint, concerning for possible ankylosing spondylitis. Aortic lacerations in patients with ankylosing spondylitis can either be from bony fragments or avulsion injuries, as the anterior longitudinal ligament can become firmly adhered to the aortic wall.12
