Korean J Leg Med.  2017 May;41(2):51-55. 10.7580/kjlm.2017.41.2.51.

Delayed Death Due to Aortic Laceration after Chest Blunt Trauma: An Autopsy Case

• Na JY

• KMID: 2379673
• DOI: http://doi.org/10.7580/kjlm.2017.41.2.51

Abstract

A traumatic aortic injury due to blunt chest trauma is well recognized. However, a delayed death due to an aortic laceration after blunt chest trauma is very rare. A 49-year-old man arrived at the emergency room after falling from a height of approximately 4 m. Upon radiological examination, multiple fractures to his left ribs with a hemopneumothorax on his left side were found. After undergoing a closed thoracostomy, he was admitted to the general ward due to his vital signs being stable. After 13 hours from his admission, he complained of chest discomfort with the sudden development of massive blood drainage through his chest tube. A cardiopulmonary resuscitation was performed, where the patient then died and an autopsy was performed 36 hours after his death. On internal examination, a small laceration of the descending aorta with irritation of the tunica adventitia was revealed. Given the findings of an additional histological examination and the aforementioned findings, the author thought that the fractured fragments of the posterior ribs had irritated the tunica adventitia of the adjacent descending aorta for some time after the chest trauma and that a perforation had finally occurred. The author here reports a case of a delayed death due to an aortic laceration after a blunt chest trauma with the patient's clinical information and full autopsy findings.

Keyword

Aorta; Lacerations; Thoracic injuries; Delayed diagnosis; Autopsy

MeSH Terms

Accidental Falls
Adventitia
Aorta
Aorta, Thoracic
Autopsy*
Cardiopulmonary Resuscitation
Chest Tubes
Delayed Diagnosis
Drainage
Emergency Service, Hospital
Fractures, Multiple
Hemopneumothorax
Humans
Lacerations*
Middle Aged
Patients' Rooms
Ribs
Thoracic Injuries
Thoracostomy
Thorax*
Vital Signs

Figure

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  Fig. 1. An axial computed tomography of the chest demonstrates a displaced fragment of the fourth rib impressing upon the descending aorta (the arrow indicates the tip of the fractured fragment of the rib).

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  Fig. 2. (A) A tunica adventitia of the descending aorta is irritated and a small laceration is noted (the arrow indicates the perforation site of the aorta). (B) Fractures of the posterior portion of the left ribs are noted at the same level of the aortic injury (the thin arrow indicates the injury site of the aorta and the thick arrow indicates bone fragments). (C) A histological examination of the aorta reveals aortic injuries (H&E, ×25). Cut surfaces of the aortic laceration were coated with fibrin, tissue from the tunica adventitia, and external elastic lamina. Additionally, a focal hemorrhage in the tunica media and diffuse hemorrhage in the tunica adventitia were noted.

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  Fig. 3. (A) Gross examination of myocardium revealed a mild whitish discoloration and multifocal hemorrhagic lesions in inferolateral aspect. (B) A histological examination of the myocardium revealed infiltration of inflammatory cells including neutrophils with myocardial necrosis (H&E, ×100).

Reference

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2.Funaki S., Inoue M., Minami M, et al. Video-assisted thoracoscopic resection of fractured ribs to prevent descending aorta injury in patient with chest trauma. Ann Thorac Cardiovasc Surg. 2014. 20:173–4.

3.Park HS., Ryu SM., Cho SJ, et al. A treatment case of delayed aortic injury: the patient with posterior rib fracture. Korean J Thorac Cardiovasc Surg. 2014. 47:406–8.