Aortic Rupture

Aka: Aortic Rupture, Traumatic Aortic Disruption, Traumatic Aortic Injury, Thoracic Aorta Injury, Traumatic Aorta Injury

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II. Epidemiology

  1. Common cause of Traumatic sudden death
    1. Motor Vehicle Accident
    2. Fall from height

III. Pathophysiology

  1. Caused by decelerating forces and Blunt Chest Trauma
  2. Alive at presentation indicates only partial injury
    1. Injury occurs most often near ligamentum arteriosum
    2. Contiguous venous Laceration
      1. Responsible for part of mediastinal blood

IV. Imaging: Classic Chest XRay findings

  1. Widened mediastinum (8 cm)
  2. Obliteration of aortic knob
  3. Mediastinal structures deviated right
    1. Deviation of trachea to right
    2. Deviation of Esophagus (or NG tube) to the right
    3. Deviation of the the right Bronchus to the right (as well as elevation)
  4. Loss of space between pulmonary artery and aorta
  5. Depression of left mainstem Bronchus
  6. Widened paratracheal stripe
  7. Widened paraspinal interfaces
  8. Pleural or apical cap present
  9. Left Pleural Effusion (Hemothorax)
  10. Associated injuries
    1. Rib Fracture of first or second rib
    2. Scapula Fracture

V. Diagnostics

  1. CT Angiogram Chest (preferred)
    1. Preferred first-line study with Test Sensitivity
  2. Aortogram
    1. Older XRay based study that is replaced by CT Angiogram
    2. Expect <10% Aortograms positive if adequately ordered
  3. Transesophageal Echocardiogram

VI. Management

  1. Beta Blocker (e.g. Esmolol) if not hypotensive
    1. Goal Mean Arterial Pressure (MAP) 60-70 mmHg
    2. Goal Heart Rate 80 bpm
  2. Emergent surgical intervention

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