Welcome to Francis Academic Press

International Journal of Frontiers in Medicine, 2022, 4(9); doi: 10.25236/IJFM.2022.040904.

Multiorgan trauma with rare fall-related aortic dissection: case report and review of the literature

Author(s)

Tao Li1, Zhonghan Wu1, Jingkun Wang1, Yuntao Tang1, Yao Zhao1, Shuisheng Yu1, Meige Zheng1, Xinzhong Xu1,2

Corresponding Author:
Xinzhong Xu
Affiliation(s)

1Department of Orthopaedics, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230000, China

2Deputy Director of Department of Surgery, the Second Affiliated Hospital of Anhui Medical University, Hefei, 230000, China

Abstract

Multiorgan trauma that includes aortic dissection most frequently results from car crashes, which is fatal in up to 90% of these patients. Rarely, similar thoracic aortic injury can be caused by falls from significant height. Such a fall in a 43-year-old Chinese man caused multiorgan trauma including multiple fractures and aortic dissection. After immediate evaluation and stabilization of the patient’s status, emergency repair of the aortic dissection was performed followed subsequently by elective surgery for the fractures. The patient was eventually discharged from hospital, and at six months follow-up, he had returned to normal living conditions. The purpose of this case report was to describe the diagnosis and treatment of this rare presentation of traumatic aortic injury as part of multiorgan trauma. Aortic dissection caused by fall injuries from height is extremely rare in clinical practice and can easily be missed or misdiagnosed. 

Keywords

multiple trauma; aortic dissection; fracture; literature review

Cite This Paper

Tao Li, Zhonghan Wu, Jingkun Wang, Yuntao Tang, Yao Zhao, Shuisheng Yu, Meige Zheng, Xinzhong Xu. Multiorgan trauma with rare fall-related aortic dissection: case report and review of the literature. International Journal of Frontiers in Medicine (2022), Vol. 4, Issue 9: 18-23. https://doi.org/10.25236/IJFM.2022.040904.

References

[1] Zelle BA, Brown SR, Panzica M, et al. The impact of below the knee joint injuries on the long-term functional outcome following polytrauma. [J]. Injury, 2005, 36 (1): 169-177. 

[2] Erbel R, Aboyans V, Boileau C, Et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). [J]. European heart journal, 2014, 35 (41): 2873-2926. 

[3] Brandon W, Propper and W. Darrin Clouse. Thoracic Aortic Endografting for Trauma: A Current Appraisal [J]. Archives of Surgery, 2010, 145 (10): 1006-1011. 

[4] Teasdale G, Mass A, Lecky F, et al. The Glasgow Coma Scale at 40 years: standing the test of time [J]. Lancet Neurology, 2014, 13 (8): 844-854. 

[5] Vincent J L. Advanced Trauma Life Support, Ninth Edition [J]. American College of Surgeons, 2012:26-27. 

[6] Mock, Charles, ed. Guidelines for trauma essential care [J]. World Health Organization, 2004:69-72. 

[7] Aladham F, Sundaram B, Williams DM, et al. Traumatic aortic injury: computerized tomographic findings at presentation and after conservative therapy. [J]. J Comput Assist Tomogr. 2010, 34 (3): 388-394. 

[8] Taeger G, Ruchholtz S, Waydhas C, et al. Damage control orthope dics in patients with multiple injuries is effective, time saving and safe [J]. J Trauma, 2005, 59 (2): 409 -416. 

[9] Boncompte MM, Sucunza AE, Louis CL, et al. Comparison of mortality due to severe multiple trauma in two comprehensive models of emergency care: Atlantic Pyrenees (France) and Navarra (Spain) [J]. J Emerge Med, 2009, 37 (2): 189-200 

[10] Jelodar S, Jafari P, Yadollahi M, et al. Potential Risk Factors of Death in Multiple Trauma Patients [J]. Emergency, 2014, 2 (4): 170-173. 

[11] Tadros RO, Tang GHL, Barnes HJ, et al. Optimal treatment of uncomplicated type B aortic dissection: JACC review topic of the week [J]. J Am Coll Cardiol, 2019, 74 (11): 1494-1504. 

[12] Schwartz SI, Durham C, Clouse WD, et al. Predictors of late aortic intervention in patients with medically treated type B aortic dissection [J]. J Vasc Surg, 2018, 67 (1): 78-84. 

[13] CifaniI N, Proietta M, Tritapepe L, et al. Stanford - Aacute aortic dissection, inflammation, and metalloproteinases: a review [J]. Ann Med, 2015, 47 (6): 441-446. 

[14] Durham CA, Aranson NJ, Ergul EA, et al. Aneurysmal degeneration of the thoracoabdominal aorta after medical management of type B aortic dissections [J]. J Vasc Surg, 2015, 62 (4): 900-906. 

[15] Li Y, Yang N, Duan WX, Et al. Acute Aortic Dissection in China [J]. The American Journal of Cardiology, 2012, 110 (7): 1056-1061. 

[16] Tolenaar JL, Froehlich W, Jonker FH, et al. Predicting in-hospital mortality in acute type B aortic dissection: evidence from International Registry of Acute Aortic Dissection [J]. Journal of Vascular Surgery, 2015, 61 (1): 282-282. 

[17] Evangelista A, Isselbacher EM, Bossone E, et al. Insights from the International Registry of Acute Aortic Dissection: a 20 -year experience of collaborative clinical research [J]. Circulation, 2018, 137 (17): 1846-1860. 

[18] Carter Y, Meissner M, Bulger E, et al. Anatomical consideration in the surgical management of blunt thoracic aortic injury [J]. J Vasc Surg, 2001, 34 (4): 628-633. 

[19] Kaewlai R, Avery LL, Asrani AV, et al. Multidetector CT of blunt thoracic trauma. [J]. Radiographics: a review of the Radiological Society of North America, Inc, 2008, 28 (6): 1555-1570. 

[20] Richens D, Field M, Neale M, et al. The mechanism of injury in blunt traumatic rupture of the aorta. [J]. European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery, 2002, 21 (2): 288-93. 

[21] Alkadhi H, Wildermuth S, Desbiolles L, et al. Vascular emergencies of the thorax after blunt and iatrogenic trauma: multi-detector row CT and three-dimensional imaging. [J]. RadioGraphics, 2004, 24 (5): 1239-1255. 

[22] Nienaber CA, Clough RE. Management of acute aortic dissection. [J]. The Lancet, 2015, 385 (9970): 800-811. 

[23] Hagan PG, Nienaber CA, Isselbacher EM, et al. The International Registry of Acute Aortic Dissection (IRAD): new insights into an old disease. [J]. JAMA: The Journal of the American Medical Association, 2000, 283 (7): 897-903. 

[24] Pape LA, Awais M, Woznicki EM, et al. Presentation, Diagnosis, and Outcomes of Acute Aortic Dissection: Seventeen-Year Trends from the International Registry of Acute Aortic Dissection. [J]. Journal of Vascular Surgery, 2016, 63 (2): 552-553. 

[25] von Kodolitsch Y, Schwartz AG and Nienaber CA. Clinical prediction ofacute aortic dissection. [J]. Arch Intem Med, 2000, 160 (19): 2977-2982. 

[26] Mussa FF, Horton JD, Moridzadeh R, et al. Acute Aortic Dissection and Intramural Hematoma: A Systematic Review [J]. JAMA, 2016, 316 (7): 754-763. 

[27] Huang B, Yang Y, Lu H, et al. Impact of d -Dimer Levels on Admission on Inhospital and Long-Term Outcome in Patients with Type A Acute Aortic Dissection. [J]. The American Journal of Cardiology, 2015, 115 (11): 1595-1600. 

[28] Mauban EC, Pyeritz R, Hutchison S, et al. Diagnostic Imaging For Acute Aortic Dissection: Imaging Sensitivity And Preference Revisited [J]. Journal of the American College of Cardiology, 2018, 71 (11): A2073-A2073. 

[29] Godry H, Rölleke G, Mumme A, et al. Traumatic Infra-Aortic Dissection After a High-energy Trauma: A Case Report of a Primary Missed Diagnosis. [ J]. Orthopedic reviews, 2014, 6 (1): 5031. 

[30] Georgiou Andrew and Lockey David. The performance and assessment of hospital trauma teams [J]. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2010, 18 (1): 66.