Blunt Traumatic Thoracic Aortic Pseudoaneurysm in a Young Adult.

Blunt thoracic aortic injury (BTAI) is a rare but potentially fatal complication of high-energy trauma. Management can be particularly challenging in polytraumatized patients when severe concomitant injuries require immediate treatment. We report the case of a 27-year-old motorcyclist who was struck by a car and underwent whole-body trauma CT. Thoracic CT angiography demonstrated a focal pseudoaneurysm of the thoracic aorta located 48 mm distal to the origin of the left subclavian artery and measuring 20 × 7.5 × 21 mm, consistent with a grade III BTAI. No mediastinal hematoma or CT evidence of free aortic rupture was identified. Abdominal CT additionally revealed AAST grade V splenic avulsion associated with a large-volume hemoperitoneum. Given the immediate hemorrhagic risk related to the splenic injury, emergency splenectomy was prioritized. After surgical stabilization, the aortic injury was successfully treated by thoracic endovascular aortic repair (TEVAR). Final angiography demonstrated satisfactory stent-graft positioning and complete exclusion of the pseudoaneurysm. This case highlights the crucial role of whole-body CT in the comprehensive assessment of polytrauma and illustrates the importance of individualized therapeutic prioritization when multiple life-threatening injuries coexist. In selected patients without evidence of free aortic rupture, treatment of an immediately threatening hemorrhagic injury may precede definitive endovascular aortic repair.