Traumatic aortic transection - Revision history

Rossdonaldson1 at 20:36, 5 May 2021

2021-05-05T20:36:21Z

← Older revision		Revision as of 20:36, 5 May 2021
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	''Not to be confused with [[nontraumatic thoracic aortic dissection]]''		''Not to be confused with [[nontraumatic thoracic aortic dissection]]''

	==Background==		==Background==
			[[File:Aorta segments.jpg\|thumb\|Aortic sebments.]]
			[[File:Aorta branches.jpg\|thumb\|Branches of the aorta.]]
	[[File:PMC3443276 13244 2012 187 Fig22 HTML.png\|thumb\|Aortic isthmus laceration with pseudoaneurysm (arrow), mediastinal hematoma, and bilateral hemothorax]]		[[File:PMC3443276 13244 2012 187 Fig22 HTML.png\|thumb\|Aortic isthmus laceration with pseudoaneurysm (arrow), mediastinal hematoma, and bilateral hemothorax]]
	*Blunt traumatic mechanism, rapid deceleration		*Blunt traumatic mechanism, rapid deceleration

Rossdonaldson1: /* Evaluation */

2020-06-16T16:54:55Z

Evaluation

← Older revision		Revision as of 16:54, 16 June 2020
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	===Diagnosis===		===Diagnosis===
	===Classification<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>===		====Classification<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>====
	[[File:PMC4330229 13244 2014 380 Fig1 HTML.png\|thumb\|(a) Grade 1: Intimal flaps at the level of the proximal descending aorta and 10 cm distal to the subclavian artery (arrowheads) with accompanying mediastinal hematoma. (b) Grade 3: large pseudoaneurysm formation. (c) and (d) Traumatic aortic transection (grade 4) with massive para-aortic hematoma.]]		[[File:PMC4330229 13244 2014 380 Fig1 HTML.png\|thumb\|(a) Grade 1: Intimal flaps at the level of the proximal descending aorta and 10 cm distal to the subclavian artery (arrowheads) with accompanying mediastinal hematoma. (b) Grade 3: large pseudoaneurysm formation. (c) and (d) Traumatic aortic transection (grade 4) with massive para-aortic hematoma.]]
	''Based on CT findings''		''Based on CT findings''

Rossdonaldson1: /* Workup */

2020-06-16T16:54:25Z

Workup

← Older revision		Revision as of 16:54, 16 June 2020
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	**Diagnostic study of choice		**Diagnostic study of choice
	**Good for aorta but not for branch vessels		**Good for aorta but not for branch vessels
	*[[CXR]]		*[[CXR]] (may be an initial screening study, but is not sensitive)
	*May be an initial screening study, but is not sensitive
	**Widened mediastinum (>8cm on supine film)		**Widened mediastinum (>8cm on supine film)
	**Left apical cap		**Left apical cap

ClaireLewis: /* Management */

2019-09-26T18:34:17Z

Management

← Older revision		Revision as of 18:34, 26 September 2019
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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 α/β-blockers, calcium-channel blockers		*Keep SBP <120, HR 60-80 with α/[[beta blockers\|β-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

Rossdonaldson1: /* Evaluation */

2019-04-23T18:26:40Z

Evaluation

← Older revision		Revision as of 18:26, 23 April 2019
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	==Evaluation==		==Evaluation==
	===Workup===		===Workup===
			[[File:PMC4040866 rju05301.png\|thumb\|Blunt thoracic aortic injury on CXR showing widened mediastinum]]
	[[File:PMC3874367 IJVM2013-797189.010.png\|thumb\|Acute traumatic aneurysm: small focal outpouching from the anterior aspect of the proximal descending thoracic aorta (curved arrow).]]		[[File:PMC3874367 IJVM2013-797189.010.png\|thumb\|Acute traumatic aneurysm: small focal outpouching from the anterior aspect of the proximal descending thoracic aorta (curved arrow).]]
	[[File:PMC3443276 13244 2012 187 Fig23 HTML.png\|thumb\|Traumatic dissection of the descending aorta. (a) Proximal border at the level of the isthmus. (b) Involvement of the abdominal part]]		[[File:PMC3443276 13244 2012 187 Fig23 HTML.png\|thumb\|Traumatic dissection of the descending aorta. (a) Proximal border at the level of the isthmus. (b) Involvement of the abdominal part]]

Rossdonaldson1: /* Management */

2019-02-26T07:06:25Z

Management

← Older revision		Revision as of 07:06, 26 February 2019
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	==Management==		==Management==
	*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 α/β-blockers, calcium-channel blockers		*Keep SBP <120, HR 60-80 with α/β-blockers, calcium-channel blockers

Rossdonaldson1: /* ClassificationAzizzadeh, 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 */

2019-02-26T07:06:06Z

ClassificationAzizzadeh, 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

← Older revision		Revision as of 07:06, 26 February 2019
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	===Diagnosis===		===Diagnosis===
	===Classification<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>===		===Classification<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>===
	[[File:PMC4330229 13244 2014 380 Fig1 HTML.png\|thumb\|(a) Grade 1: Intimal flaps ~~are demonstrated~~ at the level ~~of the upper and lower curvature~~ of the proximal descending aorta and 10 cm distal to the subclavian artery (arrowheads) with accompanying mediastinal hematoma. (b) Grade 3: large pseudoaneurysm formation. (c) and (d) Traumatic aortic transection (grade 4) with massive para-aortic hematoma.]]		[[File:PMC4330229 13244 2014 380 Fig1 HTML.png\|thumb\|(a) Grade 1: Intimal flaps at the level of the proximal descending aorta and 10 cm distal to the subclavian artery (arrowheads) with accompanying mediastinal hematoma. (b) Grade 3: large pseudoaneurysm formation. (c) and (d) Traumatic aortic transection (grade 4) with massive para-aortic hematoma.]]
	''Based on CT findings''		''Based on CT findings''
	*Type I: Intimal tear		*Type I: Intimal tear

Rossdonaldson1: /* ClassificationAzizzadeh, 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 */

2019-02-26T07:04:56Z

← Older revision		Revision as of 07:04, 26 February 2019
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	===Diagnosis===		===Diagnosis===
	===Classification<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>===		===Classification<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>===
	[[File:PMC4330229 13244 2014 380 Fig1 HTML.png\|thumb\|(a) Grade 1: Intimal flaps are demonstrated at the level of the upper and lower curvature of the proximal descending aorta and 10 cm distal to the subclavian artery (arrowheads) ~~and~~ accompanying mediastinal ~~haematoma~~. (b) Grade 3: large pseudoaneurysm formation ~~is seen in the typical position~~. (c) and (d) Traumatic aortic transection (grade 4) with massive para-aortic hematoma.]]		[[File:PMC4330229 13244 2014 380 Fig1 HTML.png\|thumb\|(a) Grade 1: Intimal flaps are demonstrated at the level of the upper and lower curvature of the proximal descending aorta and 10 cm distal to the subclavian artery (arrowheads) with accompanying mediastinal hematoma. (b) Grade 3: large pseudoaneurysm formation. (c) and (d) Traumatic aortic transection (grade 4) with massive para-aortic hematoma.]]
	''Based on CT findings''		''Based on CT findings''
	*Type I: Intimal tear		*Type I: Intimal tear

Rossdonaldson1: /* ClassificationAzizzadeh, 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 */

2019-02-26T07:03:58Z

← Older revision		Revision as of 07:03, 26 February 2019
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	===Diagnosis===		===Diagnosis===
	===Classification<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>===		===Classification<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>===
	[[File:PMC4330229 13244 2014 380 Fig1 HTML.png\|thumb\|~~Grading of traumatic aortic injury in para-sagittal CT reformations with additional schematic presentation:~~ (a) Grade 1: Intimal flaps are demonstrated at the level of the upper and lower curvature of the proximal descending aorta and 10 cm distal to the subclavian artery (arrowheads) and accompanying mediastinal haematoma. (b) Grade 3: large pseudoaneurysm formation is seen in the typical position. (c) and (d) Traumatic aortic transection (grade 4) with massive para-aortic hematoma.]]		[[File:PMC4330229 13244 2014 380 Fig1 HTML.png\|thumb\|(a) Grade 1: Intimal flaps are demonstrated at the level of the upper and lower curvature of the proximal descending aorta and 10 cm distal to the subclavian artery (arrowheads) and accompanying mediastinal haematoma. (b) Grade 3: large pseudoaneurysm formation is seen in the typical position. (c) and (d) Traumatic aortic transection (grade 4) with massive para-aortic hematoma.]]
	''Based on CT findings''		''Based on CT findings''
	*Type I: Intimal tear		*Type I: Intimal tear

Rossdonaldson1: /* Evaluation */

2019-02-26T07:03:31Z

Evaluation

← Older revision		Revision as of 07:03, 26 February 2019
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	[[File:PMC3874367 IJVM2013-797189.010.png\|thumb\|Acute traumatic aneurysm: small focal outpouching from the anterior aspect of the proximal descending thoracic aorta (curved arrow).]]		[[File:PMC3874367 IJVM2013-797189.010.png\|thumb\|Acute traumatic aneurysm: small focal outpouching from the anterior aspect of the proximal descending thoracic aorta (curved arrow).]]
	[[File:PMC3443276 13244 2012 187 Fig23 HTML.png\|thumb\|Traumatic dissection of the descending aorta. (a) Proximal border at the level of the isthmus. (b) Involvement of the abdominal part]]		[[File:PMC3443276 13244 2012 187 Fig23 HTML.png\|thumb\|Traumatic dissection of the descending aorta. (a) Proximal border at the level of the isthmus. (b) Involvement of the abdominal part]]
	[[File:PMC4330229 13244 2014 380 Fig1 HTML.png\|thumb\|Grading of traumatic aortic injury in para-sagittal CT reformations with additional schematic presentation: (a) Grade 1 injury in a 38-year-old patient after a fall from 10 m. Intimal flaps are demonstrated at the level of the upper and lower curvature of the proximal descending aorta and 10 cm distal to the subclavian artery (arrowheads) and accompanying mediastinal haematoma. (b) Grade 3 injury in a 35-year-old female patient after a motor vehicle accident. A large pseudoaneurysm formation is seen in the typical position. (c) and (d) Traumatic aortic transection (grade 4) in a 79-year-old female patient after a fall from 4 m height. There is also a massive para-aortic haematoma. The patient died immediately after the CT examination]]
	*CT		*CT
	**Diagnostic study of choice		**Diagnostic study of choice
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	===Diagnosis===		===Diagnosis===
	===Classification<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>===		===Classification<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>===
			[[File:PMC4330229 13244 2014 380 Fig1 HTML.png\|thumb\|Grading of traumatic aortic injury in para-sagittal CT reformations with additional schematic presentation: (a) Grade 1: Intimal flaps are demonstrated at the level of the upper and lower curvature of the proximal descending aorta and 10 cm distal to the subclavian artery (arrowheads) and accompanying mediastinal haematoma. (b) Grade 3: large pseudoaneurysm formation is seen in the typical position. (c) and (d) Traumatic aortic transection (grade 4) with massive para-aortic hematoma.]]
	''Based on CT findings''		''Based on CT findings''
	*Type I: Intimal tear		*Type I: Intimal tear