Review Question - QID 107370

A patient present with blunt chest trauma with mediastinum widening on chest radiographs along with sudden hypotension is likely suffering from blunt aortic injury. The patient should be treated with immediate surgical intervention along with fluids and blood products.

Blunt chest trauma (BCT) can result in a variety of conditions which, though rare, can often be fatal. For example, BCT can typically result in less severe conditions, such as myocardial contusions, pulmonary contusions, pulmonary effusions, and hemothoraces. Rarely, they also result in commonly fatal conditions such as aortic aneurysms and dissections along with ventricle wall ruptures, esophageal ruptures, and bronchial ruptures.

El-Menyar et al. discuss BCT and present their findings. They state that blunt aortic injury (BAI) can commonly lead to death either via traumatic pericardial tamponade or shock due to hypovolemia from blood extravasation. They also state that BAI is the second most common cause of death in blunt trauma patients where only 13-15% reach alive to hospitals.

Riesenmann et al. discuss the outcomes of BAI to the descending aorta. They state that in their study, the overall hospital mortality rate for the entire patient cohort was 34%. They also state that patients who underwent endovascular repair experienced a significantly lower intraoperative (0% vs 18%; P<.05) and overall hospital mortality (12% vs 37%; P<.05).

Figure A shows an AP radiograph significant for mediastinal widening. A closer look reveals true and false lumen in the ascending aorta extending into the aortic arch, evidence of a dissecting aortic aneurysm.

Incorrect Answers:
Answer 1, 2, 3, and 4: Though echocardiograms and CT scans are of value in traumatic settings, especially in relation to trauma to the chest, they are incorrect in this hemodynamically unstable patient with clear indications for surgical intervention noted by his presentation and his chest radiograph.