Review Note
Last Update: 03/02/2025 09:47 AM
Current Deck: ACG Part 2::Thoracic SSU
New Card (Unpublished)Currently Published Content
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Front
Commit #292850SS_TS 1.22 Discuss the diagnosis and management of:
- traumatic aortic disruption
Back
Commit #292850- Traumatic aortic injuries second most common cause of death after head injuries in RTA’s
- Associated with high-speed deceleration, air bag inflation associated with aortic rupture
- Signs:
- Fractured sternum/scapula
- Intrascapular murmur
- Lower limb paraplegia
- Decreased femoral pulses
- Palpable fracture of the thoracic spine
- Left sided flail chest + signs of shock
- CXR:
- Widened mediastinum
- Abnormal aortic contour
- Left sided haemothorax
- Lowered left main bronchus
- Tracheal deviation
- Left pleural apical cap
- Right sided paratracheal widening
Supine trauma chest radiograph showing widened mediastinum with deviation of the trachea to the right, depression of the left main bronchus, left apical pleural capping and increased density of the left hemithorax consistent with haemothorax. Combination of findings is highly suspicious for traumatic aortic rupture.
- Investigations:
- Angiography gold standard - highly sensitive and specific
- CT often used as screening test (100% sensitivity, 83% specificity)
- TOE prompt for bedside diagnosis
- Traumatic disruption = 80-90% occur at aortic isthmus
- Degrees of injury:
- Initial haemorrhage
- Intimal haemorrhage with laceration
- Medial laceration
- Complete laceration
- False aneurysm
- Free rupture with peri-aortic haemorrhage
- Blunt traumatic dissection of descending aorta mortality = 85%
