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

Images: Related links to external sites (from Bing)

Related Studies (from Trip Database) Open in New Window

Ontology: Aortic Rupture (C0003496)

Definition (MSH) The tearing or bursting of the wall along any portion of the AORTA, such as thoracic or abdominal. It may result from the rupture of an aneurysm or it may be due to TRAUMA.
Concepts Disease or Syndrome (T047)
MSH D001019
English Aortic Rupture, Aortic Ruptures, Ruptures, Aortic, Rupture, Aortic, Aortic Rupture [Disease/Finding], aortic rupture, rupture aortic, Aortic rupture
Swedish Aortabristning
Japanese ダイドウミャクハレツ, 大動脈破裂, 破裂性大動脈瘤, 破裂大動脈瘤, 大動脈瘤-破裂, 大動脈瘤-破裂性
Czech aorta - ruptura, Ruptura aorty, ruptura aorty
Finnish Aorttaruptuura
Russian AORTY ANEVRIZMY RAZRYV, AORTY RAZRYV, АОРТЫ АНЕВРИЗМЫ РАЗРЫВ, АОРТЫ РАЗРЫВ
Croatian AORTNA RUPTURA
Spanish Rotura de la Aorta, Ruptura Aórtica, Rotura Aórtica, Ruptura de la Aorta, Rotura aórtica
Polish Pęknięcie aorty
Hungarian Aortarepedés
Italian Rottura aortica, Rottura dell'aorta
Norwegian Aortaruptur
Portuguese Ruptura aórtica, Ruptura Aórtica
Dutch aortaruptuur, Aortaruptuur, Ruptuur, aorta-
German Aortenruptur
French Rupture aortique, Rupture de l'aorte

Ontology: Injury of thoracic aorta (C0160690)

Concepts Injury or Poisoning (T037)
ICD9 901.0
ICD10 S25.0
SnomedCT 59568004
English Injury to thoracic aorta, injury of thoracic aorta (diagnosis), injury of thoracic aorta, Injury thoracic aorta, Injury of thoracic aorta, Thoracic aorta injury, Injury of thoracic aorta (disorder)
Dutch thoracale aortaletsel, Letsel van thoracale aorta
German Verletzung der Thorakalaorta, Verletzung der Aorta thoracica
Portuguese Lesão traumática da aorta torácica
Spanish Lesión traumática de la aorta torácica, injuria de la aorta torácica, lesión traumática de la aorta torácica (trastorno), lesión traumática de la aorta torácica
Japanese 胸部大動脈損傷, キョウブダイドウミャクソンショウ
French Lésion de l'aorte thoracique
Italian Traumatismo dell'aorta toracica
Czech Poranění hrudní aorty
Korean 가슴 대동맥의 손상
Hungarian Mellkasi aorta sérülése

Ontology: Injury of aorta (C0854391)

Definition (NCI) Damage to the aorta from traumatic or pathologic processes.
Definition (NCI_CTCAE) A finding of damage to the aorta.
Concepts Injury or Poisoning (T037)
ICD10 S25.0
SnomedCT 444036008
Italian Traumatismo dell'aorta
Japanese 大動脈損傷, ダイドウミャクソンショウ
Czech Poranění aorty
English Aortic injury, Injury of aorta (disorder), Injury of aorta, Injury of aorta NOS, aortic injury, injury; aorta, aorta; injury, Aortic Injury
Spanish lesión traumática de aorta (trastorno), lesión traumática de aorta, Lesión traumática de la aorta
Hungarian Aorta-sérülés
Dutch aorta; letsel, letsel; aorta, aortaletsel
Portuguese Lesão traumática da aorta
French Lésion aortique
German Aortaverletzung