Conservative management of subdiaphragmatic aortic trauma.

A young man who survived a violent two-vehicle collision was found to have an isolated intramural haematoma of the subdiaphragmatic aorta.

• The patient was a 26-year-old man involved in a two-vehicle motor vehicle collision.
• On presentation he was haemodynamically and neurologically stable.
• Thoraco-abdominal CT revealed the subdiaphragmatic aortic intramural haematoma.
• The paper notes that isolated post-traumatic distal aortic haematomas remain rare.

The aortic injury was accompanied by other organ and skeletal injuries.

• CT showed a hepatic contusion and a splenic contusion.
• A spinal fracture was also identified on the thoraco-abdominal CT.

The aorta above and below the lesion was of narrow calibre.

• Post-processing image analysis on a workstation measured aortic diameters of 16.3 mm above and 14.7 mm below the lesion.
• The paper states that management is particularly challenging when the regional aortic diameter is narrow.

The patient was successfully managed conservatively with structured clinical and radiological follow-up.

• Management was non-operative in a patient who remained haemodynamically and neurologically stable.
• Follow-up consisted of structured clinical and radiological surveillance.
• The paper reports a successful outcome with this approach in this single case.

Traumatic thoracic aortic rupture is typically caused by rapid deceleration in road traffic accidents, most often at the aortic isthmus, whereas isolated distal aortic haematomas are rare and clinically difficult to manage.

• The aortic isthmus is described as the most common site of injury.
• Management of distal haematomas is described as highly challenging, particularly with a narrow regional aortic diameter.