Aortic Rupture

Aka: Aortic Rupture, Traumatic Aortic Disruption

1. Epidemiology
   1. Common cause of Traumatic sudden death
      1. Motor Vehicle Accident
      2. Fall from height
2. 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
3. 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
4. Diagnostics
   1. Aortogram (Gold standard)
      1. Expect <10% Aortograms positive if adequately ordered
   2. Transesophageal Echocardiogram
   3. CT Chest
      1. High False Negative Rate
5. Management
   1. Emergent surgical intervention