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
Classification
- Classification based on CT findings[1]
- Type I: Intimal tear
- Type II: Intramural hematoma
- Type III: Pseudoaneurysm
- Type IV: Rupture (free rupture, periaortic hematoma)
Clinical Features
- Symptoms
- Chest pain
- Back pain
- Shortness of breath
- Dysphagia
- Physical exam
- Seatbelt or steering wheel sign
- New murmur
- Subclavian hematoma
- Femoral pulse discrepancy
- Upper extremity HTN
- No si/sx sufficiently sensitive for dx[2]
Diagnosis
- CXR
- Widened mediastinum(>8cm on supine film)
- Enlarged aortic knob
- Left hemothorax
- Rightward tracheal deviation
- 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
Differential Diagnosis
Thoracic Trauma
- Airway/Pulmonary
- Cardiac/Vascular
- Musculoskeletal
- Other
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
References
- ↑ 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
- ↑ Kram, H. B., Appel, P. L., Wohlmuth, D. A. and Shoemaker, W. C. (1989) ‘Diagnosis of traumatic thoracic aortic rupture: A 10-year retrospective analysis’, The Annals of Thoracic Surgery, 47(2), pp. 282–286