An unusual occurrence of penetrating aortic arch injury by a ball-point pen: a case report and review of the literature

• Published in: Journal of cardiothoracic surgery 2022-12, Vol.17 (1), p.312-312, Article 312
• Main Authors: Ariaka, Herbert, Magala, John Paul, Kebba, Naomi, Kabuye, Ronald, Namirembe, Stella Magara, Mwambu, Tom Philip, Ahabwe, Kenneth, Nalule, Miriam
• Format: Article
• Language: English
• Subjects: Antipsychotics; Aorta; Aorta - injuries; Aorta, Thoracic - diagnostic imaging; Aorta, Thoracic - injuries; Aorta, Thoracic - surgery; Aortic Aneurysm, Thoracic - surgery; Aortic arch; Aortic dissection; Ball-point pen; Blood pressure; Blood Vessel Prosthesis Implantation; Brain; Case Report; Case reports; Complications; Coronary vessels; Emergency medical care; Foreign bodies; Head injuries; Hemorrhage; Humans; Injuries; Injury prevention; Literature reviews; Male; Mortality; Neck; Neck injuries; Neurological complications; Ostomy; Patients; Penetrating aortic arch injury; Primary aortic arch repair; Psychotropic drugs; Thoracic Injuries; Thorax; Traffic accidents; Traumatic brain injury; Vascular System Injuries; Wounds, Penetrating - diagnostic imaging; Wounds, Penetrating - surgery
• ISSN: 1749-8090; 1749-8090
• DOI: 10.1186/s13019-022-02057-5

Aortic arch injuries account for about 8% of thoracic aortic injuries. Penetrating zone I neck injuries account for 18% of vascular injuries in the neck and have great potential to traverse to involve thoracic vascular structures as well. The hard and soft signs of vascular injury facilitate triage of patients on an individual basis. We present a case of a ball-point pen traversing through zone I of the neck and causing penetrating aortic arch injury with minimal mediastinal haemorrhage. We present a polytrauma patient who was admitted with traumatic brain injury and a ball-point pen lodged above the sternal notch in zone I of the neck following a road traffic accident. He underwent mediastinal exploration via a median sternotomy. The ball-point pen was found penetrating the anterior wall of the aortic arch and resting in its lumen. The ball-point pen was successfully explanted and primary repair of the penetrating aortic arch injury was done. He had an uneventful recovery without any added secondary neurological complications. Penetrating aortic arch injuries are rare compared to injuries of the ascending aorta and descending aorta. They require a high index of suspicion, rapid investigation and urgent intervention in view of their high associated fatality. The ball-point pen in this case assumed the shape of a plug which acted as a seal at the site of injury preventing catastrophic exsanguination.