Surviving Acute Traumatic Transection of the Ascending Aorta and Proximal Aortic Arch

We report a 22-year-old male patient who survived clinically unapparent acute traumatic transection of the distal ascending aorta and the proximal aortic arch. Two months after the incident, the patient presented with hoarseness, respiratory distress and severe venous congestion of the upper part of the body. Echocardiography demonstrated a huge mediastinal tumour, dilated right heart chambers as well as pericardial tamponade. In the computed tomography (CT), scan rupture of the distal ascending aorta and the proximal aortic arch was found. The preserved adventitial layer, preventing immediate death from exsanguination or pericardial tamponade, distended over time forming a false aneurysm with a diameter of 9 cm, with its main part being located to the left of the trachea. Systolo-diastolic motion of the thin-walled false aneurysm led to the typical pulse-synchronous horizontal motion of the thyroid cartilage and the trachea, described as the Cardarelli sign. As a result of systolic expansion and diastolic shrinking of this huge false aneurysm, the arterial blood pressure curve of the patient perfectly imitated the blood pressure curve seen only with a properly timed intra-aortic balloon pump. In addition, the systolic blood pressure repeatedly compressed the main pulmonary trunk, which crossed the bottom of the false aneurysm, consecutively leading to clinically apparent right heart failure, serous pericardial effusion and pericardial tamponade. The patient successfully underwent ascending aortic and proximal aortic arch replacement using deep hypothermia, circulatory arrest and selective antegrade cerebral perfusion.