BLUNT
THORACIC INJURY WITH SUSPECTED INJURY TO THE THORACIC AORTA OR ARCH VESSELS
Patients who sustain
blunt thoracic trauma are at risk for injury to the heart and great vessels.
Patients should be selected for additional diagnostic studies based on either
mechanism of injury or evidence of mediastinal hematoma on chest radiograph or
both. Widening of the mediastinum alone is neither sensitive nor specific for
mediastinal hematoma. Physical findings concerning for aortic injury include
sternal and/or scapular fracture on exam or CXR findings of multiple rib
fractures and/or flail chest, upper mediastinal widening, indistinct aortic
contour, obscuration of the aortopulmonary window, widened left paraspinal
stripe, deviation of the NG tube or trachea to the right, depression of the
left mainstem bronchus and left apical cap (apical capping).
We generally perform
CTA of the thoracic aorta empirically in patients with significant deceleration
or acceleration mechanism or abnormal silhouette. If CTA is not available or
time doesn’t allow CTA, TEE intra-operatively may be an option.
Mechanisms consistent
with aortic injury:
High-speed MVC
(>30-40mph)
Substantial vehicle
deformity or associated fatalities
Unrestrained and/or
ejection from vehicle
Pedestrian struck by
vehicle
Falls > 10 feet
Hemodynamic
instability
References:
Mirvis SE, Bidwell
JK, Buddemeyer EU, et al. Imaging diagnosis of traumatic aortic rupture: A
review and experience at a major trauma center. Invest Radiol 1987;22:187- 190.
Ayella RJ, Hankins JR, Turney SZ, et al. Ruptured thoracic
aorta due to blunt trauma. J Trauma 1977;17:199-204.
Reviewed 8-17-17