Features
The injury is usually caused by high speed impacts such as those that occur in vehicle collisions and serious falls. It may be due to different rates of deceleration of the heart and the aorta, which is in a fixed position.
By far the most common site for tearing in traumatic aortic rupture is the aortic isthmus, near where the left subclavian artery branches off from the aorta (distal to left subclavian artery). An angiogram will often show an irregular outpouching beyond the takeoff of the left subclavian artery at the aortic isthmus, representing an aortic pseudoaneursym caused by the trauma.
The classical findings on a chest x ray will be widened mediastinum, apical cap, and displacement of the trachea, left main bronchus, or nasogastric tube. A normal chest x-ray does not exclude transection, but will diagnose conditions such as pneumothorax or hydrothorax. The aorta may also be torn at the point where it is connected to the heart. The aorta may be completely torn away from the heart, but patients with such injuries rarely survive very long after the injury; thus it is much more common for hospital staff to treat patients with partially torn aortas. When the aorta is partially torn, it may form a "pseudoaneurysm". In patients who do live long enough to be seen in a hospital, a majority have only a partially torn blood vessel, with the outermost adventitial layer still intact. In some of these patients, the adventitia and nearby structures within the chest may serve to prevent severe hemorrhage. After trauma, the aorta can be assessed by a CT angiogram or a direct angiogram, in which contrast is introduced into the aorta via a catheter.
Read more about this topic: Traumatic Aortic Rupture
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