What are the potential pitfalls/mimics of aortic transection?
Ductal remnants of the ductus arteriosum can cause a small diverticulum at the level of the aortic isthmus.
What are the common plain chest radiographic findings of aortic rupture?
(i) widened mediastinum; (ii) partial blurring of the aortic shadow; (iii) a left apical cap; (iv) right tracheal deviation.
There is a dissection flap which arises at the distal aortic arch with perfusion of false and true lumens. Immediately distal to this a further linear transmural density with intramural haematoma is seen and is consistent with a contained aortic transection. There is also a mediastinal haematoma.
There is a moderate-sized haematoma in the right pelvis and a filling defect in the right external iliac artery proximally in keeping with vessel injury, probably from traumatic dissection. The femoral artery is perfused distally. The stomach is fluid-filled and distended placing the patient at risk of aspiration.