Clinical Findings of Clark et al Indicating a High Risk of Aortic Rupture Following Blunt Chest Trauma

 

High risk factors associated with aortic rupture following blunt chest trauma:

(1) left hemothorax > 500 mL, especially if there is no pneumothorax

(2) pseudocoarctation (hypertension in upper extremities and weak femoral pulses)

(3) supraclavicular neck hematoma

 

Other findings associated with aortic rupture:

(4) evidence of hematoma in the superior mediastinum on chest X-ray

(5) widening of the mediastinum

 

The authors feel that a patient with blunt chest trauma and one or more of the high risk factors is a candidate for emergency thoracotomy. Prevention of massive exsanguination outweighs the benefits associated with the delay needed to perform imaging studies.