Original ArticlesClinical and radiographic indications for aortography in blunt chest trauma☆
Section snippets
Patients
During the 7-year period from January 1978 to January 1985, 76 consecutive patients with suspected thoracic aortic rupture were evaluated by history, physical examination, chest radiography, and aortography. Patients suspected of having great vessel injuries other than the thoracic aorta were excluded from the study. Patients ages ranged from 14 to 76 years (37 ± 17 years [mean ± standard deviation]); 62 patients were male and 14 were female. The medical records of all 76 patients with
Clinical findings
Symptoms were unobtainable in 17 patients (22.4%) as a result of coma caused by closed head injury. Of the 59 patients in whom symptoms could be elicited, 37 (62.7%) complained of chest pain; only seven of these patients (11.9%) had thoracic aortic rupture (Table I). However, midscapular back pain was found in 12 conscious patients (20.3%), three of whom had thoracic aortic rupture. Of the nine patients with complaints of midscapular back pain without thoracic aortic rupture, eight had thoracic
Discussion
According to Sailer,28 the first case of thoracic aortic aneurysm thought to be due to trauma was reported in 1556 by Vesalius. In today's era of high-speed motor vehicles and complex freeway systems, and estimated 7500 motor vehicle accident victims die each year as a result of thoracic aortic rupture.29 The key to successful management lies in the principles of prompt diagnosis and surgical repair.2
Data of the present series indicate that a mediastinal width greater than 8 cm seen on standard
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Reprint requests: William C. Shoemaker, M.D., Department of Surgery, Drew Postgraduate Medical School, 1621 East 120th St., Los Angeles, CA 90059.