ACR Appropriateness Criteria® blunt chest trauma—suspected aortic injury

Background Multiplane transesophageal echocardiography (TEE) and helical computed tomography (CT) of the chest have been validated separately against aortography for the diagnosis of acute traumatic aortic injuries (ATAI). However, their respective diagnostic accuracy in identifying blunt traumatic cardiovascular lesions has not been compared. Methods During a 3-yr period, 110 consecutive patients with severe blunt chest trauma (age: 41 +/- 17 yr; injury severity score: 34 +/- 14) prospectively underwent TEE and chest CT as part of their initial evaluation. Results of both imaging methods were interpreted independently by experienced investigators and subsequently compared. All cases of subadventitial acute traumatic aortic injury were surgically confirmed. Results Seventeen patients had vascular injury and 11 had cardiac lesions. TEE and CT identified all subadventitial disruptions involving the aortic isthmus (n = 10) or the ascending aorta (n = 1) that necessitated surgical repair. In contrast, CT only depicted one disruption of the innominate artery. TEE detected injuries involving the intimal or medial layer, or both, of the aortic isthmus in four patients with apparently normal CT results who underwent successful conservative treatment. All cardiac injuries but two were identified only by TEE. Conclusions In patients with severe blunt chest trauma, TEE and CT have similar diagnostic accuracy for the identification of surgical acute traumatic aortic injuy. TEE also allows the diagnosis of associated cardiac injuries and is more sensitive than CT for the identification of intimal or medial lesions of the thoracic aorta.

Download Full-text

Risk Factors Associated with Venous Thromboembolism in Isolated Blunt Chest Trauma

The American Surgeon ◽

10.1177/000313481307900526 ◽

2013 ◽

Vol 79 (5) ◽

pp. 502-505 ◽

Cited By ~ 3

Author(s):

Steven A. Kahn ◽

Heidi Schubmehl ◽

Nicole A. Stassen ◽

Ayodele Sangosanya ◽

Julius D. Cheng ◽

...

Keyword(s):

Risk Factors ◽

Mechanical Ventilation ◽

Venous Thromboembolism ◽

Blunt Chest Trauma ◽

Chest Trauma ◽

Injury Severity ◽

Aortic Injury ◽

Chest Injury ◽

Hospital Length Of Stay ◽

Thoracic Injury

Isolated chest trauma is not historically considered to be a major risk factor for venous thromboembolism (VTE). After blunt chest trauma, VTE may be underappreciated because pain, immobility, and inadequate prophylaxis as a result of hemorrhage risk may all increase the risk of VTE. This investigation determines the predictors and rate of VTE after isolated blunt chest trauma. A review of patients admitted to a Level I trauma center with chest trauma between 2007 and 2009 was performed. Demographics, injuries, VTE occurrence, prophylaxis, comorbidities, Injury Severity Score, intensive care unit/hospital length of stay, chest tube, and mechanical ventilation use were recorded. VTE rate was compared between those with isolated chest injury and those with chest injury plus extrathoracic injury. Predictors of VTE were determined with regression analysis. Three hundred seventy patients had isolated chest trauma. The incidence of VTE was 5.4 per cent (n = 20). The VTE rate in those with chest injury plus extrathoracic injury was not significantly different, 4.8 per cent (n = 56 of 1140, P = 0.58). Independent risk factors for VTE after isolated chest trauma were aortic injury ( P < 0.01, odds ratio [OR], 47.7), mechanical ventilation ( P < 0.01; OR, 6.8), more than seven rib fractures ( P < 0.01; OR, 6.1), hemothorax ( P < 0.05; OR, 3.9), hypercoagulable state ( P < 0.05; OR, 6.3), and age older than 65 years ( P < 0.05; OR, 1.03). Patients with the risk factors mentioned are at risk for VTE despite only having thoracic injury and might benefit from more aggressive surveillance and prophylaxis.

Download Full-text

Subtle abdominal aortic injury after blunt chest trauma

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2005.07.018 ◽

2006 ◽

Vol 31 (1) ◽

pp. 29-31 ◽

Cited By ~ 5

Author(s):

Geoff M. Crabb ◽

Kennedy K. McQuillen

Keyword(s):

Blunt Chest Trauma ◽

Chest Trauma ◽

Aortic Injury ◽

Abdominal Aortic

Download Full-text

Blunt aortic injury: Surgical treatment of the ascending and descending aorta

10.1510/mmcts.2021.064 ◽

2021 ◽

Keyword(s):

Surgical Treatment ◽

Surgical Approach ◽

Blunt Chest Trauma ◽

Chest Trauma ◽

Aortic Injury ◽

Ascending Aorta ◽

Descending Aorta ◽

Blunt Aortic Injury ◽

Aortic Injuries ◽

Open Surgical Approach

Traumatic aortic injury is potentially fatal. Although uncommon, involvement of the aortic arch and the ascending aorta can occur. This case shows concomitant dissection of the ascending and descending sections of the aorta after blunt chest trauma where the open surgical approach was successfully performed to treat both aortic injuries.

Download Full-text