The aorta can tear completely or incompletely after blunt chest trauma or penetrative chest trauma. The signs asymmetrical pulse or blood pressure can count, decreased blood flow to the lower extremities, and precordial systolic murmurs. The diagnosis is often made on the basis of violation of events leading and / or findings of chest X-ray and confirmed by CT, ultrasound or cartography. The treatment is open Repair or stent placement.
The aorta can tear completely or incompletely after blunt chest trauma or penetrative chest trauma. The signs asymmetrical pulse or blood pressure can count, decreased blood flow to the lower extremities, and precordial systolic murmurs. The diagnosis is often made on the basis of violation of events leading and / or findings of chest X-ray and confirmed by CT, ultrasound or cartography. The treatment is open Repair or stent placement. Etiology In blunt trauma, the usual mechanism is a serious injury delayed; Patients often have multiple rib fractures, the first and / or second rib fractures or any other manifestation of a serious chest injury. In penetrating wounds, the wound crosses usually the mediastinum (occurs eg., Between the nipples or the shoulder blades). Pathophysiology A complete tear caused rapid death by bleeding. A partial plan with fracture tends near the ligament Arterial occur (Most partial tears of the aorta occur near the ligament Arterial on.) With aufrechterhaltenem blood flow, usually by an intact adventitial. However, partial fractures can lead to limited mediastinal hematoma. Most partial tears of the aorta occur near the ligament on Arterial. Symptoms and signs Patients typically have chest pain Signs include pulse deficits of the upper extremities, a hard systolic murmur over the precordium or rear interscapular space, hoarseness, and evidence of impaired blood flow to the lower extremities, including reduced heart rate or blood pressure in the lower extremities compared to the upper extremities. Diagnostic imaging of the aorta The diagnosis should be suspected in patients with a suggestive mechanism or suggestive findings. X-ray picture is taken. Among the suggestive chest X-ray findings include the following: Advanced mediastinum (high sensitivity except in the elderly) the first or second rib fracture obliteration of Aortenknopfes deviation of the trachea or esophagus (and thus each nasogastric tube) to the right depression of the left main bronchus pleural or apical cap hemothorax, pneumothorax or pulmonary contusion However, some of these suggestive chest X-ray findings can not be present immediately. No finding or combination of findings is sufficiently sensitive or specific; therefore recommend many authorities imaging the aorta to all patients who have had a severe injury with a delay, even without suggestive findings on examination or chest radiograph. The aortic imaging study of choice varies by institution. Among the studies that are sufficiently precise to include the following: CT angiography: in stock (in most trauma centers) and fast. Aortography: Regarded as the most accurate, but is invasive (resulting in a higher rate of complications) and takes longer (typically 1 to 2 hours). Transesophageal echocardiography: Fast (usually <30 min), has a low complication rate, can detect certain associated injuries (eg to the "Innominate vessels."), Which can be seen on the CT, because it is a "bedside test ' , it can be used in unstable patients. However, the accuracy is dependent on the operator, and it is not always available. If patients are not stable enough to undergo the available imaging studies and a traumatic aortic tear is suspected as the cause of shock, immediate surgery is indicated. Therapy Blood pressure control Surgical repair or stent placement volume therapy is indicated, but an impulse control therapy (reduction of heart rate and blood pressure, usually with a ?-blockers) should be started as soon as other sources were excluded from bleeding. Goals are heart rate ? 90 beats / min and systolic blood pressure ? 120 mm Hg; and patients should not perform a Valsalva maneuver. It measures should be taken to avoid coughing and choking when patients intubation (z. B. Pre-treatment with 1 mg / kg lidocaine iv) or nasogastric intubation (z. B. avoid any resistance to tube passage) need. The definitive treatment consisted traditionally immediate surgical repair, but recent experience shows that an endovascular stent implantation is the treatment of choice today. Surgical repair may be delayed during the investigation and treatment of other potentially life-threatening injuries. Key points A partial tear of the aorta should in patients with a chest injury caused by severe delay, be considered. Chest x-ray abnormalities are common, but may be absent and are often non-specific; better aortic imaging tests include CT angiography, aortography and transesophageal echocardiography. Check the heart rate and blood pressure (usually with a ?-blocker) and insert a stent or endovascular perform surgical repair by.