AORTIC RUPTURE

Characteristics

● Eighty to ninety per cent of patients die before reaching hospital.

● Associated with deceleration injuries, such as a fall from a height or in road traffic accidents over 40 mph.

● The aorta usually ruptures at the aortic isthmus (in 88–95%), just distal to the origin of the left subclavian artery.

Clinical features

● An aortic rupture should be suspected from the mechanism of injury.

● Chest or inter-scapular pain will be present.

● Differential brachial blood pressures or different brachial and femoral pulse volumes are suggestive.

Radiological features

Chest radiograph

● Widened mediastinum (8 cm on a supine AP Chest radiograph (CXR)).

● Blurred aortic outline with loss of aortic knuckle.

● Left apical pleural cap.

● Left sided haemothorax.

● Depressed left/raised right main stem bronchus.

● Tracheal displacement to the right.

● Oesophageal NG tube displacement to the right.

CT Thorax

● Vessel wall disruption or extra-luminal blood seen in contiguity with the aorta is indicative of rupture.

Management

● Judicious fluid replacement.

● Adequate analgesia.

● Avoid hypertension (excess fluid replacement/pain, etc.).

● Urgent surgical involvement with a view to thoracotomy and repair. 

M.Vinothraj