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For your convenience, find the Trauma List Archive Below

Traumatic Aortic Rupture

Kari Schrøder Hansen trauma-list@trauma.org
Sun, 27 Jan 2002 14:20:50 +0100 

85 year old male pedestrian hit by a car (50 km/h).
Arrives ED 50 min. after the accident: Syst BP: 114. Pulse:70 GCS:14.
20 min after admission: Syst BP: 70. Pulse 100 GCS:10 Chest X-ray shows a
widened mediastinum.
After another 30 min the patient dies (at the CT-lab!). Post mortem exam.
shows rupture of aortae distal to left subclavian artery.

Some questions about traumatic aortic rupture (TAR):
1.  Most TAR occures at the location described in this case. What is the
chance for another location (outside pericard)?

2.  If our patient had been young and healthy (and with a TAR that obviously
was bleeding while in ED), what would have been the chance of saving his
life if he had gone to the OR instead of the CT-lab?

3.  When in the OR and you suspect a TAR but do not know the exact location.
Would you go for an left thoracotomy or a sternum split?

4.  Some years ago aortography was considered the "Golden standard". What is
considered as the best diagnostic tool today: aortography, helical CT or
transoesoph. sonosound? 




Kari Schrøder Hansen
Consultant
Emergency Dept.
Haukeland University Hospital
N-5121 Bergen
Norway