Snapshot
- A 22-year-old man presents to the emergency department after a high-speed motor vehicle accident. He was in the passenger seat and was wearing a seatbelt. The patient reports chest pain with breathing difficulty. Vital signs are significant for a blood pressure of 135/95 mmHg and a pulse of 105/min. On physical exam, the patient is stable with a seatbelt imprint on the skin of his chest. An anteroposterior radiograph of the chest demonstrates an obscured aortic knob. Preparations are made to get a contrast-enhanced CT scan of the chest and trauma surgery is consulted.
Introduction
- Definition
- blunt thoracic aortic injury
- Pathophysiology
- Anatomy
- this is the transition zone of a relatively more mobile ascending aorta and arch to the descending thoracic aortic, which is relatively fixed
Presentation
- Symptoms
- chest pain
- intrascapular pain
- breathing difficulty or swallowing
- Physical exam
- steering wheel or seatbelt imprint on the skin surface
- left subclavian hematoma
- new interscapular murmur
- may find
- pseudocoarctation (upper extremity hypertension)
- absent bilateral femoral pulses
Imaging
- Plain anteroposterior chest radiograph
- indication
- initial imaging of choice
- findings
- widened mediastinum
- abnormal aortic arch contour
- abnormal aortic knob
- tracheal deviation
- indication
- Tracheoesophageal echocardiography
- indication
- in hemodynamically unstable patients
- indication
- Contrast-enhanced chest CT
- indication
- in hemodynamically stable patients
Treatment
- Operative
- aortic repair
- indication
- definitive treatment
- indication
- aortic repair