Acute blunt thoracic aorta injury (BTAI) has contributed to significant number of death in motor vehicle collision (1, 2). Most of the time, thoracic aortic injury rarely manifest with obvious sign and symptoms hence high index of suspicion is necessary to catch the catastrophic injury and arrest it on its tract towards doom (3). We present a case series of 3 patients with traumatic thoracic aortic injuries, highlighting the diagnostic and management challenges of this injury in Emergency Department. Unfortunately resources are limited in the interiors of Sabah, particularly in the rurals and small districts hospitals, which mandates the transfer of our patients to level one trauma center. Two patients were transferred via air transport (MEDEVAC) to Cardiothoracic Center and underwent a successful percutaneous endovascular aortic repair. One of all three patients died due to excessive hemorrhage. All patients presenting with thoracic injuries should be assessed with a high index of suspicion for major cardiovascular injuries. Given that clinical features are sometimes unreliable, the mechanisms with high energy blunt trauma involving rapid deceleration should raise suspicion of BTAI. Abnormal chest radiograph findings, especially widening mediastinum should prompt advanced chest imaging. Early diagnosis, prompt transfer to the operating room and speedy and perfect surgery influence a favorable outcome.



Thoracic aorta injury, MEDEVAC, endovascular aortic repair, blunt trauma

1. Nagy KK, Fabian T, Rodman G. 'Guidelines for the diagnosis and management of blunt aortic injury'. EAST trauma practice guidelines committee, 2000.
2. Williams JS, Graff JA, Uku JM, Steinig JP. Aortic injury in vehicular trauma. Ann Thorac Surg. 1994; 57:726-30.
3. Katyal D, McLellan BA, Brenneman FD, et al. Lateral impact motor vehicle collisions: significant cause of blunt traumatic rupture of the thoracic aorta. J Trauma. 1997; 42:769-72.
EMAS Meeting 2018 Abtracts