DK2985_C000 1..28 - AlSharqia Echo Club

Aorta 279(A)(B)AORTICHEMATOMAAo(C)AORTIC HEMATOMA(D)(E)TLAORTIC HEMATOMAAORTIC HEMATOMAFigure 12.29 (A, B) Hematoma in the descending aorta in a 76-year-old patient. (C) The hematoma is seen on the computed tomographyscan. (D) Intraoperatively, a distended and edematous descending aorta (Ao) was seen. (E) Upon opening the aorta, the intramuralhematoma is seen (TL, true lumen). (Photos D and E courtesy of Dr. Philippe Demers.)VIII.TRAUMATIC RUPTURE OF AORTATraumatic rupture of the Ao is believed to account for up to30% of motor vehicle accidental deaths. Mortality and morbidityare still significant in patients who survive to hospitaladmission (36). The lesion commonly occurs at the aorticisthmus where the ligamentum arteriosum and left subclavianartery firmly affix the Ao to the thoracic cage(Fig. 12.2). Goarin et al. (37) recently published theirexperience in 28 patients diagnosed with traumatic disruptionof the Ao: 19 showed thick stripes at the site of disruption,15 presented an intimal flap, and 13 had fusiformaneurysms (.1.5 times normal) (Fig. 12.31). Vignon andLang (38) examined 115 trauma patients and diagnosed14 with aortic disruption (3 intimal and 11 subadventitial)yielding a sensitivity of 91% and a specificity of 100%compared with intraoperative pathology. Medial flaps arecaused by subadventitial tears and are thicker than intimalflaps as they contain both intimal and medial layers. In allcases, the medial flap runs perpendicular to the wall ofthe Ao unlike in dissections where it is most often parallel(Fig. 12.31). Medial flaps are mobile and influenced bythe flow of blood within the Ao. Intimal tears appeared asthin flaps within the aortic lumen itself.