Deceleration And Blunt Trauma

Traumatic aortic rupture is an infrequent but not rare event. Trauma represents the leading cause of death of individuals in the United States under the age of 40, with aortic rupture trailing only head trauma as the most frequent cause of death. Deceleration trauma from automobile accidents, fall from height, blast injuries, or injuries during downhill skiing or equestrian accidents appear to be the primary mechanism. In a demographic analysis of 144 patients with aortic rupture, 83% were involved in motor vehicle crashes, 4.9% in motorcycle accidents, and 9.1% in sports activities and falls from height.

The aortic region subjected to the greatest strain with vertical or horizontal deceleration trauma is the isthmus at the insertion of the ligamentum arterio-sum. Trauma may result in intimal hemorrhage with or without laceration, partial or complete laceration with periaortic hemorrhage, and possibly formation of false aneurysm. Although highly lethal, even complete aortic transsection may be survived occasionally in the presence of hematoma containing the ruptured site.

The diagnosis of aortic trauma is to be suspected in association with any high-impact deceleration trauma. Depending on the level of consciousness, patients may describe severe back and chest pain typically associated with aortic dissection. However, individuals suffering major trauma may be ventilated or sedated, eliminating the ability to describe any symptoms. A high level of suspicion in patients without pain but with severe dyspnea and/or hemodynamic

Traumatic Aortic Dissection Deceleration

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Figure 2.2. Evolutions of acute intramural hematoma of the descending aorta (left) to growing local dissection and formation of an aneurysm on spiral contrast-enhanced CAT scans within 4 months; reconstruction of the dissected aorta and exclusion of aneurysm after interventional stent-graft placement.

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Figure 2.2. Evolutions of acute intramural hematoma of the descending aorta (left) to growing local dissection and formation of an aneurysm on spiral contrast-enhanced CAT scans within 4 months; reconstruction of the dissected aorta and exclusion of aneurysm after interventional stent-graft placement.

instability and low blood pressure after blunt or deceleration trauma should trigger a diagnostic reflex to search for aortic injuries.

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