Fact-sheet: Aortic rupture
Updated on 05/30/2024 at 5:17 PM
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Definition
Complete or partial rupture of the aortic walls.
Clinical features
Often in a post-traumatic or post-surgical context
Laboratory findings
Hyperlactatemia
Radiography
Widening of the cardiomediastinal silhouette (hemopericardium).
Pleural effusion (hemothorax)
Ultrasound
Hemopericardium in particular.
Diagnosis is difficult due to the most often isthmic location of the rupture, making it hard to visualize on ultrasound
CT
Hemothorax, hemopericardium, and periaortic hematic infiltration visible as spontaneous hyperdensity (40 HU) on the non-contrast acquisition.
After injection, irregular aortic walls and the tear are visualized, with contrast extravasation contained within the wall (type II) or massive extravasation into the mediastinum (type III).
For type I rupture, the CT diagnosis can be more difficult, with simply a mural hematoma and/or an intimal "fingernail" image.
--> carefully analyze the aortic isthmus in the setting of high-kinetic-energy motor vehicle accidents.
MRI
Not performed due to immediate life-threatening emergency setting.
Vascular intervention
Irregular opacification of the aorta with contrast extravasation (grade II and III).
Management
Surgical +++
Stent grafting is possible but most often requires concurrent surgical intervention to reimplant the supra-aortic trunks.
Classification
Classification of traumatic aortic injuries by Goarin and Gavin
Stage I: intimomedial flap and/or intramural hematoma
Stage II: subadventitial rupture with pseudoaneurysm
Stage III: complete rupture
Differential diagnosis
Aortic dissection
Aortitis