Clark et al identified risk factors associated with a high risk of aortic rupture following blunt chest trauma. This can help select patients who may benefit from immediate aortography and/or emergency left thoracotomy. The authors are from the Maine Medical Center in Portland.


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.


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