Deceleration Injury: Blunt Aortic Injury

Abstract

High-speed deceleration injuries such as motor vehicle crashes and falls from great heights can lead to blunt aortic injury, which is commonly just distal to the takeoff of the left subclavian artery. Initial management includes advanced trauma life support protocols to assess airway, breathing, and circulation. Initial imaging is done with a chest x-ray, and findings concerning for a thoracic aortic injury include a widened mediastinum, apical cap, and left hemothorax, among other findings. A computed tomography (CT) scan of the chest with contrast should then be obtained to definitively diagnose an aortic injury. Blood pressure and heart rate should be maintained below 100 mmHg and 100 beats per minute, respectively, with medications. Urgent vascular or thoracic surgery consult should be obtained for definitive management. Either an endovascular or open approach can be done depending on patient stability and anatomy. Blunt aortic injury can effectively be ruled out if the CT scan is negative, and further trauma work-up should be guided by history and physical exam.