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