Aortic Dissection

Last Updated on by FRCEM Intermediate

Mechanism

Rapid deceleration injuries

X-ray findings

Several CXR features might suggest the injury according to ATLSĀ 

  • Widened mediastinum the most reliable sign
  • Fractures of the first and second ribs
  • Obliteration of the aortic knob
  • Deviation of the trachea to the right
  • Presence of a pleural cap
  • Elevation and rightward shift of the right main stem bronchus
  • Depression of the left main stem bronchus
  • Obliteration of the space between the pulmonary artery and the aorta
  • Deviation of the nasogastric tube to the right

Investigation of choice.

  • Contrast CT thorax

 

Treatment:

  • Control hypertension (systolic no more than 110 mmHg) and tachycardia with appropriate analgesia; labetalol is the agent of choice to control acute hypertension in this setting.
  • Surgical repair or endovascular stenting, which may require transfer from your facility

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