Clinical Practice and Cases in Emergency Medicine

Introduction: Blunt thoracic aortic injury is a rare but potentially fatal consequence of motor vehicle collisions. While commonly associated with hemodynamic instability, some cases present with normal vital signs, delaying diagnosis and treatment. We present the case of a 42-year-old unrestrained backseat passenger who sustained a blunt thoracic aortic injury following a motor vehicle collision and underwent emergent endovascular repair. This case emphasizes the critical role of early imaging and multidisciplinary coordination in the management of high-risk trauma patients.

Case Report: A 42-year-old female presented to the emergency department (ED) following a high-risk motor vehicle collision. She was an unbelted passenger in a vehicle traveling at approximately 35 miles per hour that collided with a telephone pole. The patient was unconscious at the scene but regained consciousness en route. Upon arrival at the ED she was alert, oriented, and hemodynamically stable. Her vital signs were as follows: blood pressure, 107/58 millimeters of mercury; heart rate, 62 beats per minute; respiratory rate, 18 breaths per minute; and oxygen saturation, 100% on room air. Physical examination revealed anterior chest wall tenderness but no signs of respiratory distress. Imaging revealed a high-grade blunt thoracic aortic injury with a left-sided hemothorax. The patient underwent emergent thoracic endovascular aortic repair and remained hemodynamically stable throughout hospitalization. 

Conclusion: Blunt thoracic aortic injury can present with hemodynamic stability despite its life-threatening nature. This case highlights the necessity of early imaging and multidisciplinary coordination in optimizing outcomes for high-risk trauma patients.