BLAST INJURY AS A CAUSE OF AN AORTIC THROMBUS

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: We report a 31-year-old male with single gunshot wound (GSW) to the left back who developed an aortic thrombosis within twenty-four hours after presentation. Vascular pathology following penetrating trauma, specifically chest, without direct injury is profoundly rare and could cause devastating sequelae. CASE PRESENTATION: A male, no past medical history, presents GSW inferior scapula. Upon imaging patient, he was found have large pneumohemothorax, lung laceration, retained missile between descending thoracic aorta eighth vertebral body in posterior mediastinum. chest tube (CT) placed immediate collection of 1500cc sanguineous output. After this initial bloody drainage, CT output decreased significantly less than 150 cc/hour, so vascular or intervention immediately planned. Notably, computerized tomography angiogram (CTA) close follow up second CTA showed injury. Repeat at 24 performed for monitoring potential which demonstrated new nonocclusive thrombus adjacent bullet fragment measured 8 x 9 mm. The patient asymptomatic, however, due increased risk distal embolization, taken urgently operating room endovascular stent placement. recovered well discharged. DISCUSSION: Ballistic has been studied extensively, especially during wartime. These projectiles shockwaves throughout area that extend beyond projectile tract can intimal vessel manifest as thrombus, dissection, aneurysm formation. With observed injury, presumed be secondary blast from GSW. previously presented case where 100% obstructing anterior cardiac artery young healthy male. This required emergent catheterization drug eluting series suggests extends damage careful attention surrounding vasculature must observed. CONCLUSIONS: Our highlights importance having high clinical suspicion tissue tracts. In series, structures were never directly injured, yet requiring operative intervention. Shockwaves caused by these formation when traveling proximity vessels. REFERENCE #1: Reade Michael, Thomas Peter. (2016). Pathophysiology ballistic trauma. 10.1093/med/9780199600830.003.0339 #2: Eletta, Olanrewaju et al. (2020) myocardial infarction https://www.sciencedirect.com/science/article/pii/S0012369220324211 #3: Shin EH, Sabino JM, Nanos GP 3rd, Valerio IL. trauma: lessons learned iraq afghanistan. Semin Plast Surg. 2015;29(1):10-19. doi:10.1055/s-0035-1544173 DISCLOSURES: No relevant relationships Kevin Dong, source=Web Response Lewis Schwartz, Amy Stewart,