Starnes et al reported a new classification for blunt aortic injury. This can help guide management of the patient. The authors are from the University of Washington and Harborview Medical Center.
Patient selection: blunt aortic injury
Patient evaluation: imaging studies of the aorta
Parameters:
(1) external contour abnormality on imaging studies
(2) length of tear and/or thrombus in mm
(3) containment/rupture
External Contour Abnormality
Length of Tear or Thrombus
Contained?
Type of Aortic Injury
absent
< 10 mm
NA
intimal tear
absent
>= 10
NA
large intimal flap
present
NA
yes
pseudoaneurysm
present
NA
no (ruptured)
rupture
If there is no external contour abnormality and no evidence of tear or thrombus then there is no evidence of aortic injury on the imaging study.
From
To
Term
aortic valve
proximal origin of the innominate artery
ascending aorta
proximal origin of the innominate artery
distal aspect of the left subclavian artery
aortic arch
distal aspect of the left subclavian artery
2 cm caudal to the left pulmonary artery
aortic isthmus
2 cm caudal to the left pulmonary artery
diaphragmatic hiatus
descending thoracic aorta
diaphragmatic hiatus
aortic bifurcation
abdominal aorta
A systolic blood pressure at presentation < 90 mm Hg had a hazard ratio of 11.4 for death.
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