A chest radiograph revealing a widened mediastinum can indicate the presence of a thoracic aortic injury; other radiographic features suggestive of aortic injury include abnormal mediastinal contour, hemothorax, pleural cap, and tracheal deviation. A contrast-enhanced CT of the chest is indicated for further evaluation.

These injuries are often life threatening, necessitating immediate identification and intervention. Blunt aortic injury is associated with high-speed deceleration and is the second leading cause of death in patients with trauma, accounting for 16% of all trauma-related deaths. Open surgical repair requires a double-lumen tube (DLT), one-lung ventilation, and clamping of the proximal aorta while taking measures to protect the spinal cord. In patients with coexisting conditions, such as increased intracranial pressure, profound bleeding, or hypoxemia, this procedure is extremely high risk and might be contraindicated. The mainstay of treatment of aortic transection includes control of blood pressure and ventricular ejection force (dP/dt) with β-blocker infusions and/or mixed β-blocker/α-antagonist medications, followed by endovascular repair. At high-volume centers, endovascular repair is associated with a higher survival benefit and decreased incidence of complications, especially paraplegia, compared to open surgical repair.

References

• Demetriades D, Velmahos GC, Scalea TM, et al. Operative repair or endovascular stent graft in blunt traumatic thoracic aortic injuries: results of an American Association for the Surgery of Trauma multicenter study. J Trauma. 2008;64:561-571.
• Fox N, Schwartz D, Salazar JH, et al. Evaluation and management of blunt traumatic aortic injury: a practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Nurs. 2015;22:99-110.
• Neschis DG, Scalea TM, Flinn WR, et al. Blunt aortic injury. N Engl J Med. 2008;359:1708-1716.