//fpnotebook.com/
Aortic Rupture
Aka: Aortic Rupture, Traumatic Aortic Disruption, Traumatic Aortic Injury, Thoracic Aorta Injury, Traumatic Aorta Injury- Epidemiology
- Common cause of Traumatic sudden death
- Motor Vehicle Accident
- Fall from height
- Common cause of Traumatic sudden death
- Pathophysiology
- Caused by decelerating forces and Blunt Chest Trauma
- Alive at presentation indicates only partial injury
- Injury occurs most often near ligamentum arteriosum
- Contiguous venous Laceration
- Responsible for part of mediastinal blood
- Imaging: Classic Chest XRay findings
- Widened mediastinum (8 cm)
- Obliteration of aortic knob
- Mediastinal structures deviated right
- Loss of space between pulmonary artery and aorta
- Depression of left mainstem Bronchus
- Widened paratracheal stripe
- Widened paraspinal interfaces
- Pleural or apical cap present
- Left Pleural Effusion (Hemothorax)
- Associated injuries
- Rib Fracture of first or second rib
- Scapula Fracture
- Diagnostics
- CT Angiogram Chest (preferred)
- Preferred first-line study with Test Sensitivity
- Aortogram
- Older XRay based study that is replaced by CT Angiogram
- Expect <10% Aortograms positive if adequately ordered
- Transesophageal Echocardiogram
- CT Angiogram Chest (preferred)
- Management
- Beta Blocker (e.g. Esmolol) if not hypotensive
- Goal Mean Arterial Pressure (MAP) 60-70 mmHg
- Goal Heart Rate 80 bpm
- Emergent surgical intervention
- Beta Blocker (e.g. Esmolol) if not hypotensive