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Miyamoto K, Sakakibara M, Yamaga H, Maeda A, Yagi M, Dohi K. Abdominal aortic injury caused by a sharp osteophyte displaced by a compression fracture: A case report and literature review. Heliyon 2024; 10:e35994. [PMID: 39220907 PMCID: PMC11365368 DOI: 10.1016/j.heliyon.2024.e35994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 08/03/2024] [Accepted: 08/07/2024] [Indexed: 09/04/2024] Open
Abstract
Osteophytes grow on vertebral bodies and sometimes form a sharp edge, which can induce traumatic abdominal aortic injury (TAAI). However, these cases are extremely rare, although osteophytes grow in almost everyone with age. Herein, we report a rare case of TAAI due to a sharp osteophyte dislocation following a compression fracture, with a literature review. An 83-year-old man presented with back pain after a fall and subsequently developed shock. His lactate level was elevated on arrival, although we could not identify the cause of the shock. Enhanced computed tomography (CT) revealed a compression fracture of the lumbar spine, a sharp osteophyte penetrating the abdominal aorta, and contrast media spurting to the retroperitoneum. We immediately transfused, administered continuous noradrenaline to maintain his vital signs, and consulted a vascular surgeon and radiologist to arrange for an emergency operation. However, the operating room was not immediately available. We tried to evacuate a trauma center, which took time due to the COVID-19 outbreak. Thereafter, the patient's condition deteriorated, resulting in a pulseless electrical activity, and he passed away 3 h after arrival. Afterward, the previous CT image and a sharp osteophyte were observed in the lumbar vertebrae in contact with the abdominal aorta. There were only eight reports where the aorta was injured by osteophytes. From our review, unlike the proportion of common TAAI, injuries due to strong external forces were relatively small. There was no specific symptom, and the vertebral levels of osteophytes were concentrated in Th12-L3. The most common morphology of aorta injuries is pseudoaneurysm formation. Moreover, five of the patients developed hemorrhage. Considering these previous reports, we should pay attention to the aorta in front of the vertebral bodies regardless of the mechanism of injury when a CT image of patients shows osteophytes.
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Affiliation(s)
- Kazuyuki Miyamoto
- Department of Emergency, Critical Care and Disaster Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
- Department of Emergency Medicine, Showa University Northern Yokohama Hospital, 35−1 Chigasaki Chuo Tsuzuki-ku, Yokohama City, 224-8503, Japan
| | - Mako Sakakibara
- Department of Emergency, Critical Care and Disaster Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
- Department of Emergency, Critical Care Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka Aoba-ku, Yokohama City, 224-8503, Japan
| | - Hiroki Yamaga
- Department of Emergency, Critical Care and Disaster Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
| | - Atsuo Maeda
- Department of Emergency, Critical Care and Disaster Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
- Department of Emergency, Critical Care Medicine, Showa University Fujigaoka Hospital, 1-30 Fujigaoka Aoba-ku, Yokohama City, 224-8503, Japan
| | - Masaharu Yagi
- Department of Emergency, Critical Care and Disaster Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
- Department of Emergency Medicine, Showa University Northern Yokohama Hospital, 35−1 Chigasaki Chuo Tsuzuki-ku, Yokohama City, 224-8503, Japan
| | - Kenji Dohi
- Department of Emergency, Critical Care and Disaster Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8555, Japan
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Kontopodis N, Ioannou CV. A Surprising Cause of Contained Aortic Rupture: Perforation from a Lumbar Osteophyte. AORTA : OFFICIAL JOURNAL OF THE AORTIC INSTITUTE AT YALE-NEW HAVEN HOSPITAL 2021; 8:184-186. [PMID: 33761564 PMCID: PMC8043809 DOI: 10.1055/s-0040-1715468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
We describe a patient with contained aortic rupture due to perforation from a protruding lumbar osteophyte, who was treated by open surgery. This case underlines that less common aortic pathologies are possible, which require a high suspicion index to be diagnosed.
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Affiliation(s)
- Nikolaos Kontopodis
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, Heraklion, Greece
| | - Christos V Ioannou
- Vascular Surgery Unit, Department of Cardiothoracic and Vascular Surgery, University Hospital of Heraklion, Heraklion, Greece
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A Case of a Paracardial Osteophyte Causing Atrial Compression. Case Rep Med 2016; 2016:4325830. [PMID: 28119739 PMCID: PMC5227134 DOI: 10.1155/2016/4325830] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 12/13/2016] [Indexed: 11/20/2022] Open
Abstract
Osteophytes are pointed or beaked osseous outgrowths at the margins of articular surfaces that are often associated with degenerative changes of articular cartilage. They are the most common aspect of osteoarthritis and they infrequently cause symptoms by compression of the adjacent anatomic structures, such as nerves, vessels, bronchi, and esophagus. We present here a rare case of a patient with a left atrial deformation by a large osteophyte.
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