Silent Threat: Post-Traumatic Aortic Pseudoaneurysm Causing Airway Compression and Respiratory Failure

Abstract

Background: Post-traumatic aortic pseudoaneurysm is a rare but life-threatening complication of blunt chest trauma. When large, it can exert significant mass effect on adjacent structures, leading to critical complications such as airway compression and pulmonary artery obstruction. Early recognition and intervention are crucial to prevent fatal outcomes.

Case Presentation: We report a case of a 17-year-old male who developed progressive dyspnea and hypoxemia over 1.5 months following a motor vehicle accident. Initial injuries included lung contusion and hemothorax, requiring mechanical ventilation and chest tube insertion. Contrast-enhanced CT revealed a large aortic arch pseudoaneurysm with a mediastinal hematoma, causing severe compression of the left main bronchus and pulmonary arteries. The resultant left lung collapse and vascular compromise led to refractory respiratory failure. Despite maximum ventilatory support, the patient remained hypoxemic, necessitating extracorporeal membrane oxygenation (ECMO) and subsequent endovascular stent graft repair. The intervention successfully relieved airway compression, leading to improved oxygenation and clinical stabilization.

Conclusion: This case highlights the potential for post-traumatic aortic pseudoaneurysms to cause airway and vascular compression, mimicking pulmonary embolism and leading to respiratory failure. Prompt imaging and endovascular intervention are critical in preventing fatal outcomes. Contrast-enhanced CT with multiplanar reconstruction is invaluable in diagnosis and management planning.