Clinical Presentation

The patient is a 27-year-old man involved in a head-on collision.

(A) Digital subtraction aortogram in the left anterior oblique (LAO) view demonstrates contour irregularity in the aortic isthmus (arrow). There is a separate origin of the left vertebral artery directly from the aortic arch. The finding is confirmed in the anteroposterior (AP) and right anterior oblique (RAO) views. (B) CT findings in aortic injury include the following: mediastinal or periaortic hematoma (white arrow), irregularity of the aortic lumen (arrowhead), hemothorax, and fractures.