Traumatic laceration of the ascending aorta: angiographic assessment

Radiographic evaluation of ascending aortic injuries is rare because they are almost always immediately fatal. We report three cases of ascending aortic laceration studied by angiography, with a review of the literature and discussion of mechanisms of injury. The type of deceleration trauma resulting in ascending aortic laceration differs from the usual driver deceleration injury in that no attenuation of force on the victim occurs at the time of impact. Traction-torsion forces on the aorta at points of fixation and increased intraluminal aortic pressure are the likely mechanisms of rupture. Adequate angiographic evaluation of these patients requires visualizing the entire aortic arch from aortic valve to diaphragm.