Updated: 4/3/2018

Traumatic Aortic Disruption

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Snapshot
  • A 22-year-old man presents to the emergency department after a high-speed motor vehicle accident. He was in the passenger seat and was wearing a seatbelt. The patient reports chest pain with breathing difficulty. Vital signs are significant for a blood pressure of 135/95 mmHg and a pulse of 105/min. On physical exam, the patient is stable with a seatbelt imprint on the skin of his chest. An anteroposterior radiograph of the chest demonstrates an obscured aortic knob. Preparations are made to get a contrast-enhanced CT scan of the chest and trauma surgery is consulted. 
Introduction
  • Definition
    • blunt thoracic aortic injury
  • Pathophysiology
    • typically results from rapid deceleration, which is seen in 
      • high-speed motor vehicle accidents (majority of cases)
      • falls from a significant height
  • 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
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
      • widened mediastinum
      • 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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(M1.CV.13.108) A 39-year-old female was involved in a head-on collision motor vehicle accident. If she was found to have a traumatic rupture of the aorta, where along the path of the aorta is the most common site of injury? Tested Concept

QID: 100624
1

Ascending aorta

32%

(20/63)

2

Site of attachment of ligamentum arteriosum

21%

(13/63)

3

Aortic isthmus

29%

(18/63)

4

Descending aorta - Thoracic aorta

10%

(6/63)

5

Abdominal aorta

6%

(4/63)

M 1 E

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