Traumatic aortic transection

Not to be confused with nontraumatic thoracic aortic dissection

Background

• Blunt traumatic mechanism, rapid deceleration
• Pt often asymptomatic but die w/o warning (80% die at scene)
• Hypotension NOT from ruptured aorta (just die)
• Need high suspicion to diagnose

Diagnosis

• CXR
  • Widened mediastinum(>8cm on supine film)
• CT
  • Diagnostic study of choice
  • Good for aorta but not for branch vessels
• Aortography
  • Gold standard
  • 25% have complications (i.e. infection & hematoma)
  • No longer routinely performed
• Classification based on CT findings<ref>Azizzadeh, A., Keyhani, K., Miller, C. C., Coogan, S. M., Safi, H. J. and Estrera, A. L. (2009) ‘Blunt traumatic aortic injury: Initial experience with endovascular repair’, Journal of Vascular Surgery, 49(6), pp. 1403–1408
  • Type I: Intimal tear
  • Type II: Intramural hematoma
  • Type III: Pseudoaneurysm
  • Type IV: Rupture (free rupture, periaortic hematoma)

Differential Diagnosis

Thoracic Trauma

• Airway/Pulmonary
  • Bronchial injury
  • Diaphragmatic trauma
  • Hemothorax
  • Pneumomediastinum
  • Pulmonary contusion
  • Tracheal injury
  • Trachobronchial injury
  • Traumatic pneumothorax
    • Tension pneumothorax
• Cardiac/Vascular
  • Cardiac injury
    • Blunt cardiac injury
      • Cardiac contusion
      • Commotio cordis
    • Penetrating cardiac injury
    • Cardiac tamponade
  • Traumatic aortic transection
• Musculoskeletal
  • Clavicle fracture
    • Clavicle fracture (peds)
  • Rib fracture
    • Flail chest
  • Scapular fracture
  • Scapulothoracic dissociation
  • Sternoclavicular dislocation
  • Sternum fracture
  • Thoracic and lumbar fractures and dislocations
• Other
  • Esophageal injury or Perforation
  • Pneumomediastinum
  • Pneumopericardium
  • Traumatic asphyxia

Treatment

• Initial medical management similar to Nontraumatic thoracic aortic dissection
• Keep SBP <120, HR 60-80 w/ alpha/beta blockers, CCBs
• Surgical management for high grade injuries

See Also

Thoracic trauma