injuries poisoning
Aortic Disruption (Traumatic)
Diagnosis of Traumatic Aortic Disruption
Aortic imaging Traumatic aortic disruption should be suspected in patients with a suggestive mechanism or suggestive findings. Chest x-ray is done. Suggestive chest x-ray findingsinclude the following: Widened mediastinum (high sensitivity except among older patients) 1st or 2nd rib fracture Obliteration of the aortic knob Deviation of the trachea or esophagus (and thus also any nasogastric tube) to the right Depression of the left mainstem bronchus Pleural or apical cap Hemothorax, pneumothorax, or pulmonary contusion However, some of these suggestive chest x-ray findings may not be present immediately. Also, no finding or combination of findings is sufficiently sensitive or specific; thus, many authorities recommend aortic imaging for all patients who have had a severe deceleration injury, even in the absence of suggestive findings on examination or chest x-ray. Theaortic imaging study of choicevaries by institution. Studies that are reasonably accurate include the following: CT angiography : Immediately available (in most trauma centers) and rapid. Uses of Angiography : Considered the most accurate but is invasive (resulting in a higher complication rate) and takes longer to complete (usually 1 to 2 hours). Techniques : Rapid (usually If patients are not stable enough to undergo any of the available imaging studies and the cause of shock is suspected to be traumatic aortic disruption, immediate surgery is indicated. 