Traumatic aortic rupture
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| Traumatic aortic rupture Classification and external resources | |
 | |
|---|---|
| The aorta, shown in red | |
| ICD-10 | S25.0, S35.0 |
| ICD-9 | 901.0, 902.0 |
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Traumatic aortic rupture, also called traumatic aortic disruption or transection, is a condition in which the aorta, the largest artery in the body, is torn or ruptured as the result of trauma. The condition is frequently fatal due to the profuse bleeding that results from the rupture. Since the aorta branches directly from the heart to supply blood to the rest of the body, the pressure within it is very great, and blood may be pumped out of a tear in the blood vessel very rapidly. This can quickly result in shock and death. Thus traumatic aortic rupture is a common killer of victims of automotive accidents and other traumas,[1] with up to 18% of deaths that occur in automobile collisions being related to the injury.[1] In fact, aortic disruption due to blunt chest trauma is the second leading cause of injury death (behind traumatic brain injury).[1]
Symptoms
The condition is difficult to detect and may go unnoticed. Most patients have no symptoms. However, a minority of patients may be hoarse, find it difficult to breathe or speak, or have shortness of breath, or have chest or upper back pain.[1] Diagnosis is further complicated by the fact that many patients with the injury experienced multiple other serious injuries as well,[1] so the attention of hospital staff may be distracted from the possibility of aortic rupture.
The preferred method of diagnosis is aortography. Though not completely reliable, chest X-rays are used to diagnose the condition.
Features
The injury is usually caused by high speed impacts such as those that occur in vehicle collisions and serious falls.[1] It may be due to different rates of deceleration of the heart and the aorta, which is in a fixed position.[1]
By far the most common site for tearing in traumatic aortic rupture is the aortic isthmus, near where the left subclavian artery branches off from the aorta.[1][1]
The aorta may also be torn at the point where it is connected to the heart. The aorta may be completely torn apart from the heart, but patients with such injuries very rarely survive for very long after the injury; thus it is much more common for hospital staff to treat patients with partially torn aortas.[1] When the aorta is partially torn, it may form a "pseudoaneurysm". In patients who do live long enough to be seen in a hospital, a majority have only a partially torn blood vessel, with the layer called the adventitia still intact.[1] In some of these patients, the adventitia and nearby structures within the chest may serve to prevent severe hemorrhage.[1]
Treatment
Traumatic aortic rupture is treated with surgery. However, morbidity and mortality rates for surgical repair of the aorta for this condition are among the highest of any cardiovascular surgery.[1] For example, surgery is associated with a high rate of paraplegia,[1] because the spinal cord is very sensitive to ischemia (lack of blood supply), and the nerve tissue can be damaged or killed by the interruption of the blood supply during surgery.
Since a high blood pressure could exacerbate the tear in the aorta or even separate it completely from the heart, which would almost inevitably kill the patient, hospital staff take measures to keep a patient's blood pressure low.[1] Such measures include giving pain medication, keeping the patient calm, and avoiding procedures that could cause gagging or vomiting.[1]
Prognosis
Death occurs immediately after traumatic rupture of the thoracic aorta 75% to 90% of the time since bleeding is so severe, and 80 to 85% of patients die before arriving at a hospital.[1] Though there is a concern that a small, stable tear in the aorta could enlarge and cause complete rupture of the aorta and heavy bleeding, this may be less common than previously believed as long as the patient's blood pressure does not get too high.[1]
See also
References
External links
- Chest Trauma: Traumatic Aortic Injury from Trauma.org
Injuries, other than fractures, dislocations, sprains and strains (S00-T14, 850-929) | |
|---|---|
| Head (head injury) and neck | Black eye - Traumatic brain injury (Concussion, Diffuse axonal injury, Cerebral contusion, Epidural hematoma, Subdural hematoma, Subarachnoid hemorrhage) |
| Thorax (chest trauma) | Traumatic aortic rupture - Pneumothorax - Hemothorax - Hemopneumothorax - Pulmonary contusion - Cardiac tamponade - Commotio cordis |
| Abdomen, lower back, lumbar spine and pelvis | Ruptured spleen |
| Shoulder and upper arm | Rotator cuff tear |
| General | Spinal cord injury - Brachial plexus lesion
Abrasion - Blister - Bruise - Hematoma Wound - Bite |
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
