Diagnosing traumatic rupture of the thoracic aorta in the emergency department

Thoracic aortic rupture (TAR) is recognised as a cause of death in victims of blunt trauma. Immediate mortality is 85% but in the group who survive to reach hospital there is a reasonable chance of successful surgical repair. TAR can be remarkably occult and the emergency physician is paramount in making the initial diagnosis. If suggestive, but often subtle features are not recognised in the early phase they will go undetected until full rupture and death occurs. This article reviews the mechanism of injury and describes the signs and symptoms of TAR in the acute phase. Features suggestive of TAR on the initial primary survey chest radiograph are described. The use of this film as a screening tool, and of other imaging modalities, is discussed.