A case involving a bovine aortic arch contributing to blunt thoracic aortic injury of triple rupture close to the pericardial reflection

A blunt thoracic aortic injury is a fatal condition that often requires emergency surgery. Although injuries to the aortic isthmus are common in trauma patients, the proximal aortic arch often remains intact. Here we describe the case of an 80-year-old man with a bovine aortic arch who presented with an aortic injury including three free rupture sites and multiple bone fractures caused by a motorcycle accident. He underwent successful total arch replacement and the frozen elephant trunk technique. The major rupture was situated at the proximal aortic arch with the tear continuing from the pericardial reflection to the first cerebral branch of the bovine aortic arch. Predisposing factors such as bovine aortic arch and impacts that occurred in a certain direction may have contributed to this unique form of rupture.