Aortic Disruption
DEFINITION
Disruption to the great artery arising from the heart .
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EPIDEMIOLOGY
Common cause of sudden death after automobile collision or a fall from
a great height.
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AETIOLOGY
Trauma.
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BIOLOGICAL
BEHAVIOUR
Disruption as the result of thoracic trauma, often rapid
deceleration.
-> Many die suddenly at the scene
-> Those that don't often have an incomplete laceration, near the
ligamentum arteriosum.
- an intact adventitial layer / mediastinal haematoma prevents
immediate death.
- persistant hypotension is then usually due to a different source in
such contained pts.
Free rupture of a transected aorta into the left chest may occur,
usually fatal unless operated on within minutes.
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MANIFESTATIONS
Little specific.
High index of suspicion required.
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INVESTIGATIONS
CXR:
1. Widened mediastinum
2. Aortic knob
obliteration
3. Tracheal devation to right
4. Obliteratioon of space between pulmonary artery and
aorta
5. Depression of left mainstem bronchus
6. Deviation of oesophagus (NG tube) to R.
7. Widened paratracheal stripe
8. Widened paraspinal interspaces
9. Pleural or apical cap.
10. Left haemothorax
11. #s 1st/2nd ribs / scapula.
False-+ve / False -ves occur with
each x-ray sign, and rarely (1-2%) no CXR abnormality in pts with great
vessel injury.
Angiography
Perform liberally - chest x-ray findings unreliable,
especially supine views.
3% will be +ve if liberal indications employed for all pts with a
widened mediastinum.
TOE
Also useful, a less invasive tool.
CT
Helical contrast enhanced CT - accurate in screening pts with suspected
blunt aortic injury.
Do not place a haemodynamically unstable pt in a CT scanner.
Sensitivity / specificity up to 100% depending on technology.
- if -ve for mediastinal blood or aortic rupture, no further diagnostic
imaging is required.
- if +ve, assess degree on aortography.
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MANAGEMENT
For immediate survivors, salvage is frequently possible is the rupture
is identified / treated early.
If slightest suspicion exists, evaluate in a facility capable or
repairing a diagnosed injury.
Either primarily repaired
Or injured area resected and grafted.
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REFERENCES