Traumatic aortic transection: Difference between revisions

(management)
No edit summary
Line 15: Line 15:


==Clinical Features==
==Clinical Features==
*Symptoms
''No signs or symptoms are sufficiently sensitive for dignosis<ref>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</ref>''
**Chest pain
===Symptoms===
**Back pain
*[[Chest pain]]
**Shortness of breath
*[[Back pain]]
**Dysphagia
*[[Shortness of breath]]
*Physical exam
*[[Dysphagia]]
**Seatbelt or steering wheel sign
 
**New murmur
===Physical exam===
**Subclavian hematoma
*Seatbelt or steering wheel sign
**Femoral pulse discrepancy
*New [[murmur]]
**Upper extremity HTN
*Subclavian hematoma
*No si/sx sufficiently sensitive for dx<ref>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</ref>
*Femoral pulse discrepancy
*Upper extremity [[hypertension]]
 


==Diagnosis==
==Diagnosis==
Line 54: Line 56:


==See Also==
==See Also==
[[Thoracic trauma]]
*[[Thoracic trauma]]
*[[Nontraumatic thoracic aortic dissection]]


==References==
==References==

Revision as of 19:51, 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

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


Diagnosis

  • CXR
    • Widened mediastinum(>8cm on supine film)
    • Left apical cap
    • Enlarged aortic knob
    • Left hemothorax
    • Rightward tracheal deviation
  • 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

Differential Diagnosis

Thoracic Trauma

Treatment

  • Management per ATLS for multiple injuries, hypotension
  • Initial medical management similar to Nontraumatic thoracic aortic dissection
  • Keep SBP <120, HR 60-80 w/ alpha/beta blockers, CCBs
  • Type I injuries may be managed conservatively[3]
  • Surgical management for type II and greater

See Also

References

  1. ↑ 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
  2. ↑ 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
  3. ↑ 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
Retrieved from "https://www.wikem.org/w/index.php?title=Traumatic_aortic_transection&oldid=49114"