An aortic transection, also known as a traumatic aortic rupture, is a type of traumatic aortic injury. It is considered the second most common cause of death associated with motor vehicle accidents.
It occurs from a near-complete tear through "all the layers" of the aorta due to trauma (e.g. motor vehicle collision or a severe fall).
It can be associated with a sudden and rapid deceleration of the heart and the aorta within the thoracic cavity.
It tends to most commonly occur in the proximal descending aorta, near where the left subclavian artery branches off from the aorta. Tethering of the aorta by the ligamentum arteriosum makes the site prone to shearing forces such as those occurring in a sudden acceleration or deceleration event
CT angiography is the mainstay of diagnosis. Features include contour disruption, active extravasation of intravenous contrast from the aorta, pseudo-aneurysm formation, an intimal flap, luminal filling defects and peri-aortic hematoma formation.
Treatment and prognosis
An aortic transection can be lethal and requires immediate surgical attention. Patients who survive to the emergency department usually have partial-thickness tears of the aortic wall with pseudoaneurysm formation.
- 1. Scott D. Steenburg, James G. Ravenel, John S. Ikonomidis, Claudio Schönholz, Scott Reeves. Acute Traumatic Aortic Injury: Imaging Evaluation and Management. (2008) Radiology. 248 (3): 748-62. doi:10.1148/radiol.2483071416 - Pubmed
- 2. J D Creasy, C Chiles, W D Routh, R B Dyer. Overview of traumatic injury of the thoracic aorta. (1997) RadioGraphics. 17 (1): 27-45. doi:10.1148/radiographics.17.1.9017797 - Pubmed
- 3. Cullen EL, Cullen LEJ, Cullen JCM, Cullen YPM. Traumatic aortic injury: CT findings, mimics, and therapeutic options. (2014) Cardiovascular Diagnosis and Therapy. 4 (3): 238-244. doi:10.3978/j.issn.2223-3652.2014.06.02 - Pubmed
- 4. Waleska M. Pabon-Ramos, David M. Williams, Peter J. Strouse. Radiologic Evaluation of Blunt Thoracic Aortic Injury in Pediatric Patients. (2012) American Journal of Roentgenology. 194 (5): 1197-203. doi:10.2214/AJR.09.2544 - Pubmed
- 5. R Marotta, A A Franchetto. The CT appearance of aortic transection. (2013) AJR. American journal of roentgenology. 166 (3): 647-51. doi:10.2214/ajr.166.3.8623643 - Pubmed
- 6. Tara A. Morgan, Scott D. Steenburg, Eliot L. Siegel, Stuart E. Mirvis. Acute Traumatic Aortic Injuries: Posttherapy Multidetector CT Findings. (2010) RadioGraphics. 30 (4): 851-67. doi:10.1148/rg.303105009 - Pubmed
- 7. J E Kuhlman, M A Pozniak, J Collins, B L Knisely. Radiographic and CT findings of blunt chest trauma: aortic injuries and looking beyond them. (1998) RadioGraphics. 18 (5): 1085-106; discussion 1107-8; quiz 1. doi:10.1148/radiographics.18.5.9747609 - Pubmed
- 8. Menon A, Ganguly G, Kaushik R, Joshi VS, Johri S. Post-traumatic 'transection' of the aorta. (2015) Medical journal, Armed Forces India. 71 (Suppl 2): S418-21. doi:10.1016/j.mjafi.2014.11.007 - Pubmed
- 9. Anton-Martina P, Willis BC, Nigrod JJ, Budolfson K, Raza D, Jamshidi R. Complete traumatic aortic transection. (2018) Journal of Paediatric Surgery Case Reports. 38: 4-8. doi:10.1016/j.epsc.2018.08.001
Related Radiopaedia articles
- acute aortic syndrome
- thoracic aortic aneurysm
- abdominal aortic aneurysm
- endovascular aneurysm repair (EVAR)
- reporting tips for aortic aneurysms
- aortic coarctation
- aortic pseudocoarctation
- cervical aortic arch
- interrupted aortic arch
- transposition of the great arteries
- variant anatomy of the aortic arch
- traumatic aortic injury