Snapshot quiz 18/3

Published: March 16, 2018

Authors: Morley RL and Hinchliffe RJ

The diagnosis is aortic transection. The patient was treated with thoracic endovascular aortic repair (TEVAR) and made an uneventful recovery. This is a blunt aortic injury at the aortic isthmus caused by rapid deceleration. It can be immediately fatal. There are four main grades of injury, ranging from intimal tear (grade I), through intramural haematoma (grade II), transection with pseudoaneurym/multiple aortic injuries (grade III) and free rupture (grade IV). Grade I is managed conservatively and grade II initially requires only close observation and repeat CT to assess stability. Urgent surgical repair (usually TEVAR) is indicated for grades III and IV.

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