A Case of Fatal Stanford Type A Aortic Dissection Caused by a Traffic Accident with Low Energy Impact

Abstract

A seemingly healthy 84-year-old female pedestrian was mildly bumped by a car, and she hit her left shoulder, flank, and lower legs when she fell down on a street. She was conscious and stable when transferred to an emergency room. She had no sign of any major injuries except minor lacerations on her legs. Repeated evaluations including chest X-ray, ECG, and focused assessment with sonography for trauma did not reveal any abnormal findings. While waiting for discharge, she started having mild chest discomfort. Unexpectedly, the third echocardiogram showed mild pericardial effusion, and a CT with contrast showed aortic dissection in the ascending aorta and infra-left subclavian aortic dissection. She was immediately transferred by a helicopter to a tertiary trauma center for emergent repair surgery. Considering the site of dissections, progression of existing intrinsic intimal tear triggered by energy impact was suspected. However, traumatic causes could not be excluded. Extra caution and diligence should be exercised when examining elderly patients in blunt trauma.

Keywords:

• aortic dissection
• traffic accident
• blunt trauma
• elderly patients

Ethical Statement

This study was performed in accordance with the principles stated in the Declaration of Helsinki. The ethical committee in Toride Medical Center approved this study to be published. A written informed consent was obtained from the patient and legal guardians for the publication of details, which can include photograph(s) and/or videos and/or case history and/or details within the text (“Material”) to be presented at any conference and published in any printed/online journals upon transfer to the hospital.

Acknowledgments

The authors are grateful to the patient, residents and paramedics who participated in this case report. Also, we thank to Dr. Corina Rosales for editing the manuscript. The content of this article was presented at 19th European Congress of Trauma and Emergency Surgery, in Valencia, Spain, in May 2018.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

No grant support or funding from persons or institutions was provided for this case report. We are not funded by any CC-BY funders.