{"ops":[{"insert":"A 28-year-old male bicyclist is brought to the emergency department about 30 minutes after he was hit by a car.\n \nIn the field, he was found to be unconscious with a Glasgow coma score (GCS) of 6, and subsequently intubated. He also had an open injury of the right leg. The affected limb was immobilized with a posterior splint.\n\nFocused assessment with sonography for trauma (FAST) is negative for fluid in all four windows, while chest and pelvic x-rays are negative for acute bony injuries. However, x-rays of the right lower extremity reveal a tibia-fibula fracture.\n"},{"insert":"\n"},{"insert":{"image":"\/storage\/case-images\/pd\/PD-S-080_en.png"}},{"insert":"\n"}]}
2
Investigate
Contrast CT Chest + Abdomen
{"ops":[{"insert":"There is an injury to the proximal descending aorta, with intimal flap formation, and an associated pseudoaneurysm.\n"}]}
CT Angiogram
{"ops":[{"insert":"There is an aortic intimal flap with a pseudoaneurysm 2 cm distal to the take-off of the left subclavian artery from the aortic arch, with disruption of the medial wall of the descending thoracic aorta.\n"}]}
