Ascending Aortic Arch Injury

Karim Brohi karim at trauma.org
Mon Jan 8 22:10:33 GMT 2007

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Dear All

36yo male motocycle injury admitted 36 hours ago.
Haemodynamically normal.

Injury complex:
---------------
GCS15, No head injury
Fracture C7 through foramen transversarium (stable)
Bilateral first rib fractures & multiple left sided fractures.
Bilateral small haemothoraces and left lung contusion.
Open fracture left femur - externally fixated at present.

Initial CT showed some upper mediastinal haematoma, thought initially to be
related to the first rib fractures.
Repeat CT today shows dissection flap in ascending aorta.  Starts above left
coronary.  No extension into neck vasculature (yet).
	Not visible on initial CT.

BP = 160 systolic -> controlled with labetalol.

Now what?
Conservative management?
Stent?
Open repair? Technique?

Karim

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