Aortic transection

Last revised by Henry Knipe on 2 Jun 2020

An aortic transection, also known as a traumatic aortic rupture, is a type of traumatic aortic injury. It is considered the second most common cause of death associated with motor vehicle accidents.

It occurs from a near-complete tear through "all the layers" of the aorta due to trauma (e.g. motor vehicle collision or a severe fall).

It can be associated with a sudden and rapid deceleration of the heart and the aorta within the thoracic cavity.

It tends to most commonly occur in the proximal descending aorta, near where the left subclavian artery branches off from the aorta. Tethering of the aorta by the ligamentum arteriosum makes the site prone to shearing forces such as those occurring in a sudden acceleration or deceleration event

CT angiography is the mainstay of diagnosis. Features include contour disruption, active extravasation of intravenous contrast from the aorta, pseudo-aneurysm formation, an intimal flap, luminal filling defects and peri-aortic hematoma formation.

An aortic transection can be lethal and requires immediate surgical attention. Patients who survive to the emergency department usually have partial-thickness tears of the aortic wall with pseudoaneurysm formation.

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