Traumatic aortic transection: Difference between revisions
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*Management per ATLS for multiple injuries, hypotension | *Management per ATLS for multiple injuries, hypotension | ||
*Initial medical management similar to [[Nontraumatic thoracic aortic dissection]] | *Initial medical management similar to [[Nontraumatic thoracic aortic dissection]] | ||
*Keep SBP <120, HR 60-80 with alpha/beta blockers, | *Keep SBP <120, HR 60-80 with alpha/beta blockers, calcium-channel blockers | ||
*Type I injuries may be managed conservatively<ref>Azizzadeh, A., Keyhani, K., Miller, C. C., Coogan, S. M., Safi, H. J. and Estrera, A. L. (2009) ‘Blunt traumatic aortic injury: Initial experience with endovascular repair’, Journal of Vascular Surgery, 49(6), pp. 1403–1408</ref> | *Type I injuries may be managed conservatively<ref>Azizzadeh, A., Keyhani, K., Miller, C. C., Coogan, S. M., Safi, H. J. and Estrera, A. L. (2009) ‘Blunt traumatic aortic injury: Initial experience with endovascular repair’, Journal of Vascular Surgery, 49(6), pp. 1403–1408</ref> | ||
*Surgical management for type II and greater | *Surgical management for type II and greater | ||
Revision as of 06:03, 3 August 2016
Not to be confused with nontraumatic thoracic aortic dissection
Background
- Blunt traumatic mechanism, rapid deceleration
- Often asymptomatic but die without warning (80% die at scene)
- Hypotension NOT from ruptured aorta (just die)
- Need high suspicion to diagnose
Classification
- Classification based on CT findings[1]
- Type I: Intimal tear
- Type II: Intramural hematoma
- Type III: Pseudoaneurysm
- Type IV: Rupture (free rupture, periaortic hematoma)
Clinical Features
No signs or symptoms are sufficiently sensitive for dignosis[2]
Symptoms
Physical exam
- Seatbelt or steering wheel sign
- New murmur
- Subclavian hematoma
- Femoral pulse discrepancy
- Upper extremity hypertension
Differential Diagnosis
Thoracic Trauma
- Airway/Pulmonary
- Cardiac/Vascular
- Musculoskeletal
- Other
Evaluation
- CXR
- Widened mediastinum (>8cm on supine film)
- Left apical cap
- Enlarged aortic knob
- Left hemothorax
- Rightward tracheal/esophageal deviation
- Depression of L mainstem bronchus
- Elevation of R mainstem bronchus
- Widened paratracheal stripe
- Widened paraspinal interfaces
- CT
- Diagnostic study of choice
- Good for aorta but not for branch vessels
- Aortography
- Gold standard
- 25% have complications (i.e. infection & hematoma)
- No longer routinely performed
Management
- Management per ATLS for multiple injuries, hypotension
- Initial medical management similar to Nontraumatic thoracic aortic dissection
- Keep SBP <120, HR 60-80 with alpha/beta blockers, calcium-channel blockers
- Type I injuries may be managed conservatively[3]
- Surgical management for type II and greater
Disposition
- Admission
See Also
References
- ↑ Azizzadeh, A., Keyhani, K., Miller, C. C., Coogan, S. M., Safi, H. J. and Estrera, A. L. (2009) ‘Blunt traumatic aortic injury: Initial experience with endovascular repair’, Journal of Vascular Surgery, 49(6), pp. 1403–1408
- ↑ Kram, H. B., Appel, P. L., Wohlmuth, D. A. and Shoemaker, W. C. (1989) ‘Diagnosis of traumatic thoracic aortic rupture: A 10-year retrospective analysis’, The Annals of Thoracic Surgery, 47(2), pp. 282–286
- ↑ Azizzadeh, A., Keyhani, K., Miller, C. C., Coogan, S. M., Safi, H. J. and Estrera, A. L. (2009) ‘Blunt traumatic aortic injury: Initial experience with endovascular repair’, Journal of Vascular Surgery, 49(6), pp. 1403–1408