[25 cases of traumatic rupture of the thoracic aorta: current diagnostic elements]

Traumatic rupture of the descending thoracic aorta is lethal within 3 weeks in 95% of patients who do not undergo operation. In this series of 25 patients who were operated on, 84% have survived for 6 years and there have been no cases of paraplegia. The mechanism of injury is most important in the investigation of patients with traumatic injuries and must be sought either from the patient or from witnesses. A history of rapid deceleration (more than 60 km/h) following a highway collision was present in all our cases. Failure to wear seat-belts resulted in 70% of patients being ejected from a vehicle. A side-on collision resulting in lateral deceleration caused trauma to the intrathoracic aorta in 45% of cases. Vertical deceleration resulted from falls from great heights (bridge, overpass) in 25% of cases. Clinical signs of diagnostic importance were: arterial hypertension (60%), systolic murmur (35%) and the pseudocoarctation syndrome (25%). Pertinent signs on chest roentgenograms were present in 95% of cases and included widening of the mediastinum and blunting of the aortic knob. The authors conclude thoracic aortography should be carried out in trauma patients when two or more of the following are present: (a) history of rapid deceleration, ejection from a vehicle or lateral collision, (b) hypertension and (c) blunting or modification of the aortic knob. The presence of a pseudocoarctation syndrome is an absolute indication for aortography.