Thoracic aorta injury

Thoracic aorta injury

Anatomy of the thoracic aorta
Classification and external resources
ICD-10	S25.0
ICD-9-CM	441, 901.0
MedlinePlus	001062
eMedicine	radio/44

Injury of the thoracic aorta refers to any injury which affects the portion of the aorta which lies within the chest cavity. Injuries of the thoracic aorta are usually the result of physical trauma; however, they can also be the result of a pathological process. The main causes of this injury are deceleration (such as a car accident) and crush injuries.

Classification

There are inconsistencies in the terminology of aortic injury. There are several terms which are interchangeably used to describe injury to the aorta such as tear, laceration, transection, and rupture. Laceration is used as a term for the consequence of a tear, whereas a transection is a section across an axis or cross section. For all intents and purposes, the latter is used when a tear occurs across all or nearly all of the circumference of the aorta. Rupture is defined as a forcible disruption of tissue. Some disagree with the usage of rupture as they believe it implies that a tear is incompatible with life; however, the term accurately gauges the severity of tears in the aorta. A rupture can be either complete or partial, and can be classified further by the position of the tear.^[1]

Causes

Injuries to the aorta are usually the result of trauma, such as deceleration and crush injuries. Deceleration injuries almost always occur during high speed impacts, such as those in motor vehicle crashes and falls from a substantial height. Several mechanical processes can occur and are reflected in the injury itself. A more recently proposed mechanism is that the aorta can be compressed between bony structures (such as the manubrium, clavicle, and first rib) and the spine. In the ascending aorta (the portion of the aorta which is almost vertical), one mechanism of injury is torsion (a two-way twisting).^[1]

References

1 2 Creasy JD, Chiles C, Routh WD, Dyer RB (1997). "Overview of traumatic injury of the thoracic aorta". Radiographics : a review publication of the Radiological Society of North America, Inc. 17 (1): 27–45. PMID 9017797. Retrieved 2008-10-27.

Chest injury, excluding fractures (S20–S29, 860–862)

Cardiac and circulatory system injuries	vascular: Traumatic aortic rupture Thoracic aorta injury heart: Myocardial contusion/Commotio cordis Cardiac tamponade Hemopericardium Myocardial rupture

Lung and lower respiratory tract injuries	Pneumothorax Hemothorax Hemopneumothorax Pulmonary contusion Pulmonary laceration Tracheobronchial injury Diaphragmatic rupture

Trauma

Principles

Assessment

Clinical prediction rules	Revised Trauma Score Injury Severity Score Abbreviated Injury Scale NACA score

Investigations	Diagnostic peritoneal lavage Focused assessment with sonography for trauma

Management

Principles	Advanced trauma life support Trauma surgery Trauma center Trauma team Damage control surgery Early appropriate care

Procedures	Resuscitative thoracotomy

Pathophysiology

Injury	MSK Bone fracture Joint dislocation Degloving Soft tissue injury Resp Flail chest Pneumothorax Hemothorax Diaphragmatic rupture Pulmonary contusion Cardio Internal bleeding Thoracic aorta injury Cardiac tamponade GI Blunt kidney trauma Ruptured spleen Neuro Penetrating head injury Traumatic brain injury Intracranial hemorrhage

Mechanism	Blast injury Blunt trauma Burn Penetrating trauma Crush injury Stab wound Ballistic trauma Electrocution

Region	Abdominal trauma Chest trauma Facial trauma Head injury Spinal cord injury

Demographic	Geriatric trauma Pediatric trauma

Complications

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