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Traumatic thoracic aortic rupture: investigation determines outcome
M W Hills1, S G Thomas, P A McDougall
1Department of Surgery, Westmead Hospital, New South Wales, Australia.
Summary
Early diagnosis of blunt thoracic aortic rupture (TAR) is critical for survival. Urgent arch aortography is the gold standard diagnostic tool, as other imaging like CT scans can delay care and are not effective for TAR.
Area of Science:
- Trauma Surgery
- Diagnostic Imaging
- Emergency Medicine
Background:
- Blunt thoracic aortic rupture (TAR) is a life-threatening injury often presenting with subtle signs.
- Timely diagnosis and treatment are crucial for patient survival.
- The diagnostic approach for TAR, particularly the role of different imaging modalities, requires clarification.
Observation:
- A retrospective review identified 38 patients with TAR over a 7-year period.
- Mortality was high, with 34% dead on arrival and 13% dying after thoracotomy.
- Only 47% of patients survived long enough for investigation; 9 of these 18 survived.
Findings:
- Arch aortography was performed in 13 patients, and survival was only achieved in those who underwent this procedure.
- Chest CT scans were found to be of no value and potentially delayed definitive diagnosis via aortography.
- Blind thoracotomy did not improve survival rates.
Implications:
- Early suspicion of thoracic aortic rupture necessitates urgent arch aortography.
- Arch aortography remains the definitive diagnostic standard for blunt thoracic aortic rupture.
- Current diagnostic strategies, including CT scans, may be inadequate or detrimental in managing TAR.