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Updated: Dec 8 2021

Traumatic Aortic Disruption

  • Snapshot
    • A 25-year-old man presents to the emergency department after a high-speed motor vehicle accident. He was the driver in the accident and was wearing his seatbelt. The patient reports chest pain with breathing difficulty. Vital signs are significant for a blood pressure of 137/95 mmHg and a pulse of 108/min. On physical exam, the patient is stable with a seatbelt and steering wheel imprint on the skin of his chest. An anteroposterior radiograph of the chest demonstrates an obscured aortic knob and widened mediastinum. Preparations are made to get a contrast-enhanced CT scan of the chest and trauma surgery is consulted.
  • Introduction
    • Definition
      • blunt thoracic aortic injury
    • Anatomy
      • aortic isthmus (most commonly affected)
        • distal to the left subclavian artery
        • this is the transition zone of a relatively more mobile ascending aorta and arch to the descending thoracic aortic, which is relatively fixed
    • Pathophysiology
      • typically results from rapid deceleration, which is seen in
        • high-speed motor vehicle accidents (majority of cases)
        • falls from a significant height
  • Presentation
    • Symptoms
      • chest pain
      • intrascapular pain
      • breathing difficulty or swallowing
    • Physical exam
      • steering wheel or seatbelt imprint on the skin surface
      • left subclavian hematoma
      • new interscapular murmur
      • may find
        • pseudocoarctation (upper extremity hypertension)
        • absent bilateral femoral pulses
  • Imaging
    • Plain anteroposterior chest radiograph
      • indication
        • initial imaging of choice
      • findings
        • abnormal aortic arch contour
        • abnormal aortic knob
        • tracheal deviation
    • Tracheoesophageal echocardiography
      • indication
        • in hemodynamically unstable patients
    • Contrast-enhanced chest CT
      • indication
        • in hemodynamically stable patients
  • Treatment
    • Operative
      • aortic repair
        • indication
          • definitive treatment
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