Hemoptysis as a rare manifestation of missed blunt thoracic aorta injury, a case report

Introduction and importance: Blunt thoracic aorta injury is one of the most fatal injuries in multiple trauma patients and most of these injuries lead to death at the scene. Some patients remain undiagnosed because of the lack of specific symptoms for these injuries. Hemoptysis as a presentation of a neglected blunt aortic trauma is a very rare condition. In this study, we present a case with a 7-month delay in presentation and diagnosis.Case presentation: A 49-year-old man with a complaint of intermittent hemoptysis was presented to the clinic. He had a history of chest trauma following falling 7 months ago. His physical examination was unremarkable. On Computed Tomography Angiography (CTA) pseudoaneurysm of the descending aorta was detected and the patient was treated urgently with a stent graft.Clinical discussion: Blunt thoracic aorta injury may occur following deceleration traumas. Descending aorta is the most involved segment but other segments may be involved as well. Bleeding can be stopped by tamponading the aorta with its overlying pleura. In some cases, pseudoaneurysms are formed and may remain undiagnosed for a long time after index trauma. CTA is the most useful diagnostic study and when the diagnosis is made, urgent treatment is mandatory. Although endovascular repair has significantly lower mortality and morbidity, open surgical repair may be inevitable in some cases.Conclusion: Thoracic aorta injury should be suspected in any patient with severe deceleration trauma and CTA should be used promptly for the diagnosis and treatment of these potentially fatal injuries.