Cases reported "Aortic Rupture"

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1/19. aortic rupture as a result of low velocity crush.

    A case of aortic disruption in a 35 year old lorry driver is described. This occurred as a result of a low velocity crushing force. Clinicians should be aware that this mechanism of injury may result in aortic disruption as well as the more commonly mentioned severe deceleration force.
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2/19. Immediate endovascular repair for descending thoracic aortic transection secondary to blunt trauma.

    PURPOSE: To report the immediate endovascular treatment of a thoracic aortic tear secondary to blunt trauma. methods AND RESULTS: A 39-year-old man was injured in a motor vehicle collision. In addition to significant trauma to the head, chest, and abdomen, there were signs of a deceleration injury to the thoracic aorta. After urgent celiotomy to repair a lacerated spleen, the thoracic aortic transection was treated intraluminally using an endograft made of Gianturco Z-stents covered with polytetrafluoroethylene. The patient recovered from his injuries, and the thoracic endograft shows no evidence of endoleak 7 months after treatment. CONCLUSIONS: Endoluminal techniques can be used successfully in the immediate repair of thoracic aortic injuries.
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3/19. Prehospital rounds. The quick stop.

    The coroner's post-mortem examination revealed a tom aorta. This case illustrates that although a patient may appear stable, a major catastrophic event may nonetheless be taking place. How many times have we responded to MVAs similar to the one described here and seen those involved deny injuries? We carry a higher suspicion of aortic injury after someone has been ejected from a vehicle or involved in a high-speed crash. That's not always the case, however, and understanding how internal organs respond to high-speed impacts is crucial. Damage to the aorta may result after a sudden deceleration injury of any type: a fall, vehicle crash or violence. The most common forms of traumatic aortic injury occur where the aorta is "tethered" in place: at its intersection with the heart and at its distal portion just beneath the left subclavian artery near the ligamenta arteriosum. Approximately 80% of patients with aortic injury die at the scene. The injury may be hidden in the other 20%, but they have the potential to rapidly deteriorate and die. Those who survive typically are at a trauma center and are cared for by providers who have a suspicion of the injury. A high index of suspicion should be maintained on all rapid-deceleration injuries and with patients who experience chest pain, dyspnea, a difference in pressure between the upper and lower extremities, and paralysis. paralysis can occur when aortic injury cuts off blood supply [table: see text] to the spinal cord. The spinal cord obtains its blood supply from arteries coming directly off the aorta, and a torn aorta can shear off these vessels, leaving the spinal cord to infarct and the patient to lose all distal function. When a victim sustains a sudden-deceleration injury to the chest, signs of aortic injury should be sought. It is imperative to maintain a high index of suspicion throughout patient care and be aware that although a patient may appear to be quite stable, the reality might be otherwise, and rapid transport to a trauma center will be necessary to save their life.
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4/19. Ruptured aneurysm of the left sinus of valsalva discovered 41 years after a decelerational injury.

    We present an unusual case of ruptured aneurysm of the left sinus of valsalva discovered 41 years after a car accident. echocardiography was a key element in establishing the diagnosis of this rare anomaly, which is often congenital but has also been reported as acquired or traumatic in origin.
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5/19. Late manifestation of a pseudoaneurysm in the descending thoracic aorta.

    Rupture of the descending aorta following deceleration trauma is a catastrophic event because it has a high mortality. Prompt surgical treatment is generally considered to be mandatory. However, a few injured patients may leave the hospital with an undiagnosed aortic rupture which may give rise to a chronic pseudoaneurysm. In this report, a 28-year-old man is presented in whom a pseudoaneurysm of the descending thoracic aortic was diagnosed six months after a car accident.
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6/19. aortic rupture complicating a fracture of an ankylosed thoracic spine. A case report.

    A 34-year-old man was injured in a motorcycle accident and suffered both aortic rupture and thoracic spinal fracture, complicated by an underlying undetected ankylosing spondylitis. The latter disease can affect the integrity of vascular and spinal structure. aortography is recommended as a high priority for the patient in an unstable cardiovascular condition requiring a definitive diagnosis. aortic rupture and thoracic spine fracture may occur from high energy deceleration trauma. Motor vehicle passenger and pedestrian injuries are most commonly involved, although airline accidents and high falls also generate some cases. Mediastinal widening, displacement of esophagus and trachea, apical dissection of blood, and, especially, paravertebral pleural space widening are common to both injuries. Whereas most mediastinal hematomas are nonaortic in origin, a combined injury must be considered because clinical features may also overlap. These include hypotension (hypovolemic or spinal shock), paraplegia, and severe back pain. In light of the high mortality and time constraints associated with aortic rupture, immediate diagnostic resolution is necessary for appropriate management and priority of investigation.
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7/19. Mid-descending aortic traumatic aneurysms.

    Two patients with traumatic rupture of the mid-descending aorta successfully repaired are presented. Most clinical series of aortic tears do not include this entity. A review of the world literature reveals only 9 previous cases. In 6 of the 11 patients the diagnosis was either missed or delayed. In 4 patients the diagnosis was delayed or missed because of the absence of a superior mediastinal hematoma, and in 2 patients the diagnosis was delayed because of inadequate (single-plane) aortography. Suspicion may be lacking because of absence of the upper mediastinal hematoma considered to be the sine qua non for the diagnosis of aortic rupture. Although deceleration is considered to be the mechanism of injury in tears at the isthmus, severe hyperextension (often associated with fracture dislocation of the underlying thoracic vertebra) is considered to be the causative factor in descending aortic tears. Experience with the 2 patients presented here demonstrates that a high index of suspicion and complete two-plane aortography is required to avoid the potential for catastrophic outcome subsequent to overlooking a tear of the mid-descending aorta.
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8/19. Intra-aortic balloon pump for combined myocardial contusion and thoracic aortic rupture.

    The coexistence of myocardial contusion and thoracic aortic injury is probably more common than recognized following rapid deceleration multisystem trauma. This report describes the successful application of intra-aortic balloon counterpulsation in a critically injured patient requiring emergent repair of a thoracic aortic tear complicated by ventricular failure due to cardiac contusion.
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9/19. Traumatic rupture of the thoracic aorta. A clinicopathological study.

    In a county hospital serving a population of roughly 240,000, the hospital records from the period 1982 to 1987 included 27 patients who presented with traumatic rupture of the thoracic aorta. Eighteen patients died instantaneously, one was dead on admission, five died in hospital and three survived operation. Two patients had direct cross clamping of the aorta and Dacron interposition graft soon after admission; both survived. The third patient had a Gott shunt and Dacron interposition graft the day after the accident and survived with paraplegia. In all patients who died in hospital except one, the condition was not diagnosed before death. We conclude that traumatic rupture of the thoracic aorta occurs more frequently than is generally thought. Although most patients die at the scene of the accident, a liberal use of angiography is indicated in all trauma cases admitted to hospital with a history of a forceful deceleration or acceleration injury.
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10/19. Aortoiliac occlusion secondary to atherosclerotic plaque rupture as the result of blunt trauma.

    Abdominal aortic injuries secondary to blunt trauma are uncommon, particularly without associated visceral injury or external signs of localized trauma. Blunt trauma-induced abdominal aortic injuries most frequently result in intimal tearing. The most common mechanism is localized impact over the lower abdomen from sudden deceleration against a fixed object. We present the case of a patient with atheromatous plaque rupture in the distal abdominal aorta associated with acute aortoiliac occlusion as the result of a fall. Atherosclerotic disease may be present in young asymptomatic individuals and may be a predisposing factor for aortic intimal tearing. A high degree of suspicion and periodic reassessment of peripheral circulation in trauma patients are required to ensure early diagnosis of this injury.
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