Blunt Aortic Injury

Blunt Aortic Injury - Blunt Aortic Injury Greg Magee...

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December 24, 2011 Stanford University Medical Center Blunt Aortic Injury Greg Magee
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December 24, 2011 2 Blunt Aortic Injury Causes Associated injuries Diagnosis Treatment Case studies (3 last week)
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December 24, 2011 3 Blunt Aortic Injury First characterized in detail by Parmley et al. in 1958 38 pts, 2 survived Conclusion: Prompt dx required to avert exsanguination from aortic rupture Parmley L, Mattingly T, Manion T, et al. Nonpenetrating traumatic injury of the aorta. Circulation  1958;XVII:1086-1101.
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December 24, 2011 4 Blunt Aortic Injury Caused by high acceleration/deceleration e.g. MVA, MCA, ped vs. auto CXR Suspicion if: widened mediastinum (although only present in 2/3 of cases) Indistinct aortic knob (21%) ¼ of cases have normal CXRs Fabian T, Davis K, Gavant M, Croce M, Melton S, Patton J, Haan C, Weiman D, Pate J.  Prospective Study of Blunt Aortic Injury. University of Tennessee. Ann Surg 1998;227(5):666- 77.
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December 24, 2011 5 Associated injuries Closed head – 39% Closed head w/ bleed – 22% Rib fxs – 68% Lung contusion – 42% Pelvic fx – 34% Femur fx – 25% Tibial fx – 25% Facial fx – 25% Liver – 25% Spleen – 13%
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December 24, 2011 6 Diagnosis Gold standard historically aortography Newer evidence supports use of CT angiogram Very sensitive But more false positives Fabian T, Richardson J, Croce M, et al. Prospective study of blunt aortic injury: multicenter trial  of the American Association for the Surgery of Trauma. University of Tennesse. J Trauma  1997;42:374-83. Fabian T, Davis K, Gavant M, Croce M, Melton S, Patton J, Haan C, Weiman D, Pate J.  Prospective Study of Blunt Aortic Injury. University of Tennessee. Ann Surg 1998;227(5):666- 77.
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December 24, 2011 7 Diagnosis Advantages of CT over aortography: 1) easier, faster, less invasive, less expensive 2) pts likely to get CTs for other injuries 3) reconstructions can be made 4) CT may be better at dx # & extent of injuries
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December 24, 2011 8 CT angio One prospective study evaluated 8000+ CTs for blunt torso trauma over 4 years
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This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

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Blunt Aortic Injury - Blunt Aortic Injury Greg Magee...

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