Table Of Contents
Aortic Disease Overview
Watch ▶Aortic dissections and aneurysms: Pathology review
Watch ▶Abdominal aortic aneurysm: Clinical sciences
Watch ▶Aortic dissection: Clinical sciences

Traumatic Aortic Rupture
- Commonly occurs due to trauma and/or deceleration injury
- Most commonly at aortic isthmus (proximal descending aorta just distal to origin of left subclavian artery).
- Common symptoms include tachycardia, and hypotention (hemorrhagic shock).
- In hypotensive patients, systolic blood pressure is generally kept at <100 mm Hg to prevent injury extension and rebleeding while awaiting emergent operative repair.
- CXR may also show left-sided effusion due to hemothorax (this can also happen in aortic dissection)
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Diagnosis
- Chest x-ray is the initial screening test for suspected blunt aortic trauma
- May reveal widened mediastinum.
- Abnormal enlargement of the mediastinum seen on imaging studies such as chest x-rays and CT scans.
- Caused by various conditions, e.g., aortic aneurysm, thymoma, lymphadenopathy, and traumatic injuries.
- Should be used to rule out aortic injury in patients with blunt deceleration trauma (MVA or fall from > 10 feet)
- Confirm via CT Scan or TTE

- Other Widened mediastinum pictures
Aortic Dissection
General
- Aortic dissection involves a tear in the intimal layer of the aorta, leading to separation of the aortic wall layers.
- It is classified into two Stanford types:
- Type A
- Involves the ascending aorta.
- Type B
- Involves the descending aorta distal to the subclavian artery.
Risk Factors
-
Aortic diseases
- Hypertension (Strongest risk factor)
- Thoracic aortic aneurysm
- Atherosclerosis
-
Connective tissue disorders (Marfan syndrome, Ehlers-Danlos syndrome)
<aside>
💡
Marfan is common cause for dissection in younger patients <40 🆚 HTN >60
</aside>
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Structural abnormalities (bicuspid aortic valve, Turner syndrome)
-
Inflammatory conditions (syphilis aortitis)
Clinical Features
- Pain
- Severe chest pain often described as tearing or ripping, frequently radiating to the back.
- Asymmetric Blood Pressure:
- Difference > 20 mm Hg between arms.
- Initial Findings may include a widened mediastinum on chest X-ray.

Diagnosis
-
X-Ray is the initial test for suspected aortic dissection → shows widened mediastinum, aortic knob [A]
![[A]](https://prod-files-secure.s3.us-west-2.amazonaws.com/0bb009f6-6796-4774-9490-4577fe72297a/a3366592-657b-4ccf-9d0d-9bc9e59ef7f7/image.png)
[A]
-
CT angiography (CTA) is the test of choice in hemodynamically stable patients.

- Another imaging
- Transesophageal echocardiography (TEE)
- In hemodynamically unstable patients
- Those with contraindications to CT (e.g., chronic kidney disease, contrast allergy).

Management
- General Measures
- Maintain heart rate < 60 bpm and systolic blood pressure between 100-120 mmHg.
- First-line ⇒ Intravenous beta-blockers (e.g., esmolol, labetalol).
- Nitroprusside can be added if blood pressure remains elevated.
- IV opioid analgesia
- Definitive Measures
- Type A Dissection
- Surgical emergency requiring immediate intervention.
- Type B Dissection
- Initially managed medically unless complications develop or the dissection progresses.
- Options include endovascular or open surgical repair.

Complications
- Type A (Ascending +/- Descending) Complications
- Caused by Extension of the aortic dissection
- Potential for myocardial infarction, stroke, aortic regurgitation, cardiac tamponade, Horner's syndrome, vocal cord paralysis.
- Type B (Descending only) Complications
- Risk of limb, renal, or mesenteric ischemia.
- Acute aortic dissection