Major mediastinal vessel injury: an underestimated lesion

Of patients who sustain traumatic rupture of the aorta, 15% to 20% will reach the hospital alive. Without associated major brain trauma or irreversible abdominal injury, survival depends on early diagnosis and prompt surgical repair by an experienced surgeon. Regardless of whether there is radiologic evidence of rupture or rib fractures, a constant awareness of aortic rupture should be maintained, based on the history of the accident. Among 50 patients in whom a rupture of the thoracic aorta was diagnosed, 47 with traumatic rupture of the descending thoracic aorta were treated by the author. Of 34 involved in motor vehicle accidents and in whom a history of the accident was obtained, 30 (88%) were not wearing seat belts and 11 (33%) were involved in a lateral collision. Six percent of the 50 patients sustained a vertical fall of more than 10 m.