40 Anais XXXVII COMU 2018 Embolic shower following blunt aortic injury: a risky yet successful approach Academic authors: Alissom Vitti Cincoto, Leonardo Kenji Sakaue Koyama Academic advisors: Francisco de Sales Collet e Silva, Adriano Ribeiro Meyer Pfug, Edivaldo Massazo Utiyama Faculdade de Medicina da Universidade de São Paulo - FMUSP Introduction: Blunt Aortic Injury (BAI) is a rare event in high-energy traumas. It has an estimated incidence of 20 to 30 per 1 million population per year. Its importance, however, rely in the outstanding mortality rates, in which 80 to 90% of the patients die at the scene of injury and 50% of the survivors die at the hospital (1). The majority of BAI occur in the thoracic aorta and there are less than 10 described cases of foating aortic thrombus (FAT) secondary a BAI, from which no thromboembolic complication was described (2). Objective: We report a case of a large thoraco-abdominal BAI following thrombotic dissemination with multiple ischemic foci, an extremely rare complication of high energy traumas, and its management. Case Report: A 38-year-old previously healthy man was brought to our emergency department with a history of a 10-meter fall from a paragliding. He underwent primary evaluation which revealed a hemothorax, that was promptly drained, and signs of hypovolemic shock with no signs of pelvic stability and a painful abdomen. He was stabilized with volume resuscitation and norepinephrine, and no bleeding was found in a FAST protocol ultrasound. Additionally, he had a faccid paraplegia, crepitation in the 10th and 11th ribs on the right and 10th on the left and referred pain in the palpation of T12 to S1. No bleeding was seen in the urethral catheterization or in a digital rectal examination. A tomographic scan suggested an aortic hematoma in D9-D10, ischemic lesions in spleen and left kidney and fractures of the ribs and the right transverse processes of T12 to L5 (Image 1). Also, a thrombus imaging was visualized in the abdominal aorta (Image 2). A laparotomy was performed, which confrmed the ischemic splenic lesion and found many nonpulsatile hemorrhagic foci in mesocolon, intestines and in the retroperitoneal space (Image 3). As there was thromboembolic evidence, we introduced prophylactic heparin in the immediate post operative (PO) and sent the patient to the intensive care unit (ICU). He evolved with pulmonary thromboembolism in the 3rd PO, with therapeutic enoxaparin introduced. The patient was discharged from the ICU in the 7th PO, he evolved with progressive improvement of the cardiovascular, respiratory and pain parameters, a Rev Med (São Paulo). 2018;97(Suppl. 1):40-1. XXXVII COMU 2018 – Congresso Médico Universitário da FMUSP Researches Classifed – Panel Awards – Case Report brought to you by CORE View metadata, citation and similar papers at core.ac.uk provided by Cadernos Espinosanos (E-Journal)