Aortic transection, or aortic rupture, is a rare diagnosis in trauma patients and carries a high mortality.
We present the case of a 61-year-old man presenting to a Level I trauma center after being struck by a motor vehicle, found to have an aortic transection. He was initially hypotensive and resuscitated with blood products due to concern for hemorrhagic shock. Aortic injury was suspected after chest x-ray study demonstrated a widened mediastinum. Traumatic thoracic aortic transection with pseudoaneurysm was diagnosed on computed tomography of the aorta, and the patient was taken to the operating room for thoracic endovascular repair of the aorta.
Why Should an Emergency Physician Be Aware of This?
Diagnosis of aortic injury can be challenging, especially in trauma patients presenting with hypotension. Aortic injury must be suspected in patients presenting after a high-velocity mechanism injury. It is an uncommon cause of hemorrhagic shock in trauma patients and must be considered even if other traumatic injuries are identified, as it commonly occurs with other significant injuries. Although chest x-ray study can be useful, a negative chest x-ray study does not rule out aortic injury. Aortic injury is a time-sensitive diagnosis, and early identification is key to these patients surviving to receive definitive management in the operating room.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Emergency Medicine
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Incidence and crash mechanisms of aortic injury during the past decade.J Trauma. 2007; 62: 664-667
- The mechanisms of traumatic rupture of the thoracic aorta.Br J Surg. 1977; 64: 166-173
- Prospective study of blunt aortic injury: Multicenter Trial of the American Association for the Surgery of Trauma.J Trauma. 1997; 42: 374-380
- Blunt aortic injury.N Engl J Med. 2008; 359: 1708-1716
- Traumatic aortic rupture: 30 years of experience.Ann Vasc Surg. 2011; 25: 474-480
- Blunt traumatic aortic injury: initial experience with endovascular repair.J Vasc Surg. 2009; 49: 1403-1408
- Endovascular repair of traumatic thoracic aortic injury: clinical practice guidelines of the Society for Vascular Surgery.J Vasc Surg. 2011; 53: 187-192
- Aortic injury in vehicular trauma.Ann Thorac Surg. 1994; 57: 726-730
- Thoracic aortic injury: how predictive is mechanism and is chest computed tomography a reliable screening tool? A prospective study of 1,561 patients.J Trauma. 2000; 48: 673-682
- Traumatic rupture of the thoracic aorta. An autopsy and histopathological study.S Afr Med J. 1985; 67: 383-385
- Blunt thoracic aortic injury: endovascular repair is now the standard.J Am Coll Surg. 2019; 228: 605-610
- 2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the diagnosis and management of patients with thoracic aortic disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, American Association for Thoracic Surgery, American College of Radiology, American Stroke Association, Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of Thoracic Surgeons, and Society for Vascular Medicine.Circulation. 2010; 121: e266-e369
- Radiographic manifestations of mediastinal hemorrhage from blunt chest trauma.Ann Thorac Surg. 1984; 37: 171-178
- The evolution of chest computed tomography for the definitive diagnosis of blunt aortic injury: a single-center experience.J Trauma. 2004; 56: 243-250
- Prospective study of blunt aortic injury: helical CT is diagnostic and antihypertensive therapy reduces rupture.Ann Surg. 1998; 227: 666-676
- The diagnosis and management of hypertensive crises.Chest. 2000; 118: 214-227
Published online: March 28, 2020
Accepted: February 16, 2020
Received in revised form: January 28, 2020
Received: November 13, 2019
This case report does not reflect the views or opinions of the U.S. government, Department of Defense, U.S. Army, U.S. Air Force, or the San Antonio Uniformed Services Health Education Consortium Emergency Medicine (SAUSHEC EM) Residency Program.
Published by Elsevier Inc.