A Rational Approach To Traumatic Aortic Rupture

Twenty-four patients with deceleration trauma and widened mediastinums have been studied for aortic laceration. Eight had lacerations. Analysis of the chest films demonstrates that the findings of aortic laceration are those of mediastinal bleeding and are nonspecific. While deceleration trauma appears to be causative, a widened mediastinum with such trauma is not diagnostic of aortic laceration. Upright films often cannot be obtained and are not necessary. Serial chest films are contraindicated. Aortography is the definitive technique and should be performed if clinical suspicion of aortic laceration exists.

Laceration of the thoracic aorta caused by rapid decleration injury is a surgical emergency. Less than 20% of these patients reach the emergency room alive and, of these, 90% will exsanguinate within four weeks, 25% within 24 hours.¹ Therefore prompt diagnosis and surgery are imperative. The chest film findings of aortic laceration are nonspecific since any mediastinal bleeding can give the same radiographic appearance. Aortography must be performed to confirm this diagnosis. We have recently seen 24 patients with severe decelera tion injuries all of whom had mediastinal abnormalities suggestive of aortic laceration. Eight actually had lacerations and these cases form the basis for this report.