0071643192.pdf

Aortic Injury/Traumatic Rupture of the Aorta (TRA)

MECHANISMS

■ Consider in the setting of high-speed deceleration and lateral impact MVCs
■ Consider in presence of multiple rib fractures or flail chest (although one-
third of blunt aortic injuries have no obvious external thoracic injury)

SYMPTOMS/EXAM

■ Retrosternal or interscapular pain
■ Dysphagia
■ Shortness of breath
■ Stridor or hoarseness in the absence of laryngeal injury
■ Harsh murmur over precordium or space between the scapula
■ Signs of superior vena cava syndrome
■ Hypotension

DIAGNOSIS

■ Compare BP in upper versus lower extremities (upper extremity hypertension
suggests acute coarctation syndrome).
■ CXR (10% of initial CXR in patients with TRA are completely normal)
(see Table 3.8)
■ Widened mediastinum(see Figure 3.12)
■ Defined by a width >8 cm on a supine AP film
■ Sensitivities are estimated at 50–92%.
■ Specificity is estimated at 10%. Often the mediastinum will be wide
in patients who do not have TRA.
■ Esophageal deviation
■ Loss of distinct aortic knob
■ Loss of paraspinal stripe/displacement of right paraspinous interface
■ Widening of the right paratracheal stripe
■ Loss of clear space between aortic knob and left pulmonary artery
(apical cap)
■ Displacement of left main stem bronchus 40° below horizontal TRAUMA

TABLE 3.8.CXR Findings Suggesting Aortic Injury

Widened mediastinum

Esophageal deviation

Loss of distinct aortic knob

Loss of paraspinal stripe/displacement of right paraspinous interface

Widening of the right paratracheal stripe

Loss of clear space between aortic knob and left pulmonary artery (apical cap)

Displacement of left main stem bronchus 40° below horizontal

Dissection of the descending

aorta (Stanford type B or

Debakey type III) is usually

managed medically.

Traumatic rupture of the aorta

is almost always treated

surgically, regardless of

location.

Half of all patients with TRA

who reach the hospital and

survive for 1 hour die within

24 hours, and 75% die within

7 days.