Images in cardiovascular medicine A lucky man who survived traumatic aortic rupture Javad Kojuri a , Reza Mollazadeh a and Ahmad Ali Amirghofran b Journal of Cardiovascular Medicine 2008, 9:209 a Cardiology Department and b Cardiac Surgery Department, Nemazee Hospital, Shiraz, Iran Correspondence to Reza Mollazadeh, Cardiology Department, Nemazee Hospital, Zand Avenue, Shiraz, Iran Tel: +98 917 3133749; fax: +98 711 6261089; e-mail: molla2283310@yahoo.com Received 11 December 2006 Revised 5 February 2007 Accepted 12 February 2007 The patient was a 30-year-old man who was brought to hospital after his car flipped over while he was driving without fastened seatbelt. Both legs were fractured. A few days after admission to the orthopaedic ward, the patient developed sudden onset of dyspnoea, chest pain and persistent blood pressure elevation (220/120 mmHg). Because of high suspicion of aortic dissection or rupture, the patient was sent for a spiral chest computed tomography scan with intravenous contrast injection, which revealed a tear in the distal part of the aortic arch, contrast extravasation around the aorta extending a few centimetres into the descending aorta, bilateral hemothorax (especially on the left side) and alveolar infiltration (Fig. 1a). After control of blood pressure with nitroprusside and propranolol, in order to confirm the diagnosis and to achieve a better evaluation, trans- oesophageal echocardiography was performed, which was diagnostic for aortic rupture (Fig. 1b). The patient was brought to the operating room in an emergency and an aortic transection was identified proximal to the isthmus for a length of 4 cm (Fig. 1c). The damaged segment of the aorta was replaced with a Dacron graft. Postoperative recovery was uneventful. Traumatic aortic rupture is a life-threatening injury, usually occurring in the region of the aortic isthmus [1]; therefore early diagnosis and prompt treatment are man- datory. Diagnostic modalities are spiral chest computed tomography scan, magnetic resonance imaging, transoeso- phageal echocardiography,and aortography [2]. Treatment modalities include surgery or endovascular approach [3]. References 1 Fabian TC, Richardson JD, Croce MA, Smith JS Jr, Rodman G Jr, Kearney PA, et al. Prospective study of blunt aortic injury: Multicenter Trial of the American Association for the Surgery of Trauma. J Trauma 1997; 42:347–380. 2 Kodali S, Jamieson WR, Leia-Stephens M, Miyagishima RT, Janusz MT, Tyers GF. Traumatic rupture of thoracic aorta. A 20-year review: 1969–1989. Circulation 1991; 84 (Suppl):III40–III46. 3 Pratesi C, Dorigo W, Troisi N, Pratesi G, Santoro G, Stefano P, et al. Acute traumatic rupture of the descending thoracic aorta: endovascular treatment. Am J Surg 2006; 192:291–295. Fig. 1 (a) Spiral chest computed tomography scan with intravenous contrast injection showing a tear in the distal part of the aortic arch and contrast extravasation around the aorta (Ao) (arrow). (b) Transoesophageal echocardiography showing aortic rupture and pseudoaneurysm formation around the tear site. (c) The cavity of the pseudoaneurysm (arrow). 1558-2027 � 2008 Italian Federation of Cardiology Copyright © Italian Federation of Cardiology. Unauthorized reproduction of this article is prohibited.