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
