A 62-year-old man had pain in the neck and upper thorax. He had lost his voice due to left recurrent nerve pressure paralysis. Computed tomography (CT) scan revealed a large saccular distal aortic arch aneurysm. This is typical for trauma. Deceleration forces, as in car accidents, can tear the aortic wall at the point where the ligamentum arteriosum fixates the aorta [
1]. This left-handed patient had suffered repetitive deceleration forces to the left upper thorax due to the kick of a rifle, using a large bullet size. Furthermore he used a right-handed rifle with poor fit on the left thorax, which easily displaces during recoil, causing a less well absorbed kick. Family history was positive for abdominal aneurysm, but his aorta and coronary arteries showed no significant atherosclerosis. Recently myelofibrosis was diagnosed. …
