Calcified Thoracic Mass as a Sign of Old Blunt Aortic Trauma: An Interesting Case of Aortic Pseudoaneurysm

Blunt aortic trauma is a relatively rare fatal event with a high acute mortality rate of more than 80% on the scene. If the patient survives the primary injury, high clinical suspicion is necessary for diagnosis. The main mechanism of the trauma is reported to be deceleration injury or falling from a height. Herein, we describe a 37-year-old healthy male on a heavy weight lifting job for many years with a left upper mediastinum calcified mass incidentally discovered 18 years after blunt chest trauma. Transthoracic echocardiography and contrast-enhanced chest computed tomography scan revealed an aortic pseudoaneurysm just after the isthmus without descending aortic flow limitation, which was subjected to endovascular repair. High clinical suspicion is necessary for the diagnosis of aortic injury during blunt chest trauma. Atypical symptoms late after a traumatic event may be a manifestation of missed traumatic aortic rupture. Surgical repair, percutaneous intervention, or hybrid approaches are proposed for the management of this ominous scenario. (Iranian Heart Journal 2022; 23(4): 115-119)