Commentary on 'blunt aortic injury'.

摘要

Blunt thoracic aortic (TA) trauma is a rare event in patients reaching hospital care and is diagnosed in about 0.3% of blunt trauma admissions. However, this is the tip of the iceberg, and this injury is a common finding in blunt trauma deaths. In a recent autopsy analysis of 304 blunt trauma fatalities in Los Angeles, the incidence of TA rupture was about 33%. For those patients reaching hospital care, early diagnosis and appropriate treatment are essential for good outcomes. Screening for TA injury by means of chest film is not a reliable tool, and all patients with suspicious mechanisms of injury should be evaluated by routine chest computed tomography (CT) scan. The new generation multislice CT scan is highly sensitive and specific and has replaced diagnostic angiography in the majority of cases. Diagnostic transesophageal echocardiography (TEE) should be reserved only for the rare occasion of intensive care unit patients who are too unstable to be moved to the CT scan.