Blunt Aortic Injury

 

VBMC TRAUMA CARE SERVICES GUIDELINE

 

Blunt Aortic Injury

 

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.