Traumatic Aortic Transection with Right-sided Hemothorax – An Atypical Presentation

Blunt thoracic aortic injury is a devastating entity and is a common cause of mortality following road traffic injury (RTI), only second to intracranial hemorrhage. Many of these patients may have subtle signs on initial evaluation and can be managed satisfactorily with a high index of suspension. A 26-year-old male was brought to level 1 trauma center following RTI of a four-wheeler colliding with a tree. The patient was received with unrecordable vitals except for a feeble carotid pulse and was a nonresponder to initial resuscitation. He had a cardiac arrest on reception and was revived after cardiopulmonary resuscitation. He was taken to the operating room immediately. On exploration, transection of the descending aorta with massive right-sided hemothorax with grade-IV liver injury was seen. The patient had another cardiac arrest on the operating table and could not be revived despite the best possible resuscitation efforts. Injuries to the descending aorta usually bleed into the left hemithorax due to its anatomical course, but even in right-sided hemothorax, a strong suspicion of injury to the descending aorta has to be considered, especially in patients with unstable vitals with no other obvious injuries.