USMLE Forum Archives - USMLE Step 3 - Aortic Rupture
Aortic Rupture
meduploader - 06-11-09 13:12
About 90 percent of patients with aortic rupture die within minutes, and of those who arrive at the hospital alive, another 90% will die. Most ruptures are due to auto accidents, with the site of rupture just beyond the left subclavian artery near the ligamentum arteriosum. The mechanism of injury is sudden motion of the heart and great vessels within the thorax, rather than direct crushing. Many patients will therefore have little external evidence of serious chest trauma. Clinical Findings: Physical exam findings are rarely helpful. Weak leg pulses with hypertension in the arms, or a new murmur may suggest the diagnosis. Aortic rupture is more likely in patients with 1st or 2nd rib fractures. Diagnosis: Order aortography when you suspect the diagnosis based on chest x-ray or physical exam findings. Chest x-ray may show deviation of the NG tube 1-2 cm to the right or blurring of the aortic knob. A widened upper mediastinum, deviation of the trachea to the right, a “pleural cap,” or loss of the clear space between the aorta and pulmonary artery may also suggest the diagnosis. Treatment: Rapid fluid resuscitation while awaiting surgical repair.
meduploader - 06-11-09 13:12
About 90 percent of patients with aortic rupture die within minutes, and of those who arrive at the hospital alive, another 90% will die. Most ruptures are due to auto accidents, with the site of rupture just beyond the left subclavian artery near the ligamentum arteriosum. The mechanism of injury is sudden motion of the heart and great vessels within the thorax, rather than direct crushing. Many patients will therefore have little external evidence of serious chest trauma. Clinical Findings: Physical exam findings are rarely helpful. Weak leg pulses with hypertension in the arms, or a new murmur may suggest the diagnosis. Aortic rupture is more likely in patients with 1st or 2nd rib fractures. Diagnosis: Order aortography when you suspect the diagnosis based on chest x-ray or physical exam findings. Chest x-ray may show deviation of the NG tube 1-2 cm to the right or blurring of the aortic knob. A widened upper mediastinum, deviation of the trachea to the right, a “pleural cap,” or loss of the clear space between the aorta and pulmonary artery may also suggest the diagnosis. Treatment: Rapid fluid resuscitation while awaiting surgical repair.
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#1
Re: Aortic Rupture conym5 - 06-17-09 02:07 If the fracture of scapula, sternum, clavicle, 1st rib is present , we always have to rule out Aortic Rupture even if pt is asymptoatic
#2
Re: Aortic Rupture mtniharika - 11-22-09 02:27 The classical findings on a chest x ray will be widened mediastinum, apical cap, and displacement of the trachea, left main bronchus, or nasogastric tube.A normal chest x-ray does not exclude transection, but will diagnose conditions such as pneumothorax or hydrothorax.
#3
Re: Aortic Rupture babbu5508 - 02-23-11 02:03 By far the most common site for tearing in traumatic aortic rupture is the aortic isthmus, near where the left subclavian artery branches off from the aorta (distal to left subclavian artery).
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