CT diagnosis of laceration of the main pulmonary artery after blunt trauma.

Case Report A 69-year-old man who was not wearing a seat belt presented to the emergency department after his car was struck from the rear by a bus. His medical history was notable for coronary artery bypass surgery. He was resuscitated at the accident scene and in the emergency department. Fast sonography and peritoneal lavage were performed in the trauma department and had negative findings. A portable chest radiograph was obtamed in the emergency department and showed an obviously widened mediastinum, nonvisualization of the aortic knob, and multiple left rib fractures (Fig. 1A). Because the trauma surgeon had ordered CT of the brain, cervical spine, abdomen, and pelvis before requesting aortography, the attending radiologist elected to also perform helical chest CT during administration of a single bolus of 150 ml of IV contrast material. Contrast-enhanced CT of the chest (Figs. 1B-lD) revealed a large anterior mediastinal hematoma primarily in the prevascular space extending caudally anterior to the heart and pulmonary artery. There was active extravasation of contrast material from the anterior aspect of the main pulmonary artery. No evidence of aortic pseudoaneurysm was found. and a clear fat plane was seen between the mediastinal hematoma and the aortic arch. A left hemothorax was also seen. The diagnosis of main pulmonary artery injury with active bleeding or pseudoaneurysm formation was made. The patient was taken directly to the operating room. where a laceration of the main pulmonary artery was successfully repaired. The bleeding was not contained