Traumatic aortic transection: Difference between revisions
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**25% have complications (i.e. infection & hematoma) | **25% have complications (i.e. infection & hematoma) | ||
**No longer routinely performed | **No longer routinely performed | ||
*Classification based on CT findings<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 based on CT findings<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: Intimal tear | **Type I: Intimal tear | ||
**Type II: Intramural hematoma | **Type II: Intramural hematoma | ||
Revision as of 13:29, 30 November 2015
Not to be confused with nontraumatic thoracic aortic dissection
Background
- Blunt traumatic mechanism, rapid deceleration
- Pt often asymptomatic but die w/o warning (80% die at scene)
- Hypotension NOT from ruptured aorta (just die)
- Need high suspicion to diagnose
Diagnosis
- CXR
- Widened mediastinum(>8cm on supine film)
- 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
- Classification based on CT findings[1]
- Type I: Intimal tear
- Type II: Intramural hematoma
- Type III: Pseudoaneurysm
- Type IV: Rupture (free rupture, periaortic hematoma)
Differential Diagnosis
Thoracic Trauma
- Airway/Pulmonary
- Cardiac/Vascular
- Musculoskeletal
- Other
Treatment
- Initial medical management similar to Nontraumatic thoracic aortic dissection
- Keep SBP <120, HR 60-80 w/ alpha/beta blockers, CCBs
- Surgical management for high grade injuries
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