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Injury to the Aorta

By Thomas G. Weiser, MD, MPH, Department of Surgery, Section of Trauma & Critical Care, Stanford University School of Medicine

The aorta—the largest artery in the body—can be partially or completely torn by severe blunt force to the chest.

  • People with this injury have severe chest pain and often weak pulses, hoarseness, or shock.

  • A chest x-ray is taken, and another imaging test, such as computed tomography (CT) angiography, ultrasonography, or aortography, is often also done.

  • Traumatic aortic disruption is an emergency.

  • After blood pressure and heart rate are controlled, surgery is done to repair the injury.

The heart pumps blood to the entire body through the aorta. Thus, a tear (disruption) in the aorta is a life-threatening emergency. People with a large tear usually die before they reach the hospital.

Aortic disruption is commonly caused by a high-speed motor vehicle crash or a fall from a height. People often also have rib fractures and other severe injuries.

Symptoms

People usually have severe chest pain because the chest wall is injured. Some people are hoarse or have weak pulses, particularly in the legs or feet. The feet and hands may be cool, sweaty, and blue. People may have symptoms of shock, such as low blood pressure, difficulty breathing, and confusion.

Diagnosis

  • Imaging

A chest x-ray is required for anyone who has had a chest injury. However, a tear in the aorta may not be seen on a chest x-ray, and overlooking this injury may have serious consequences. Thus, other imaging tests, such as computed tomography (CT) angiography, echocardiography, ultrasonography, or aortography (angiography of the aorta—see Table: Common Types of Angiography), are often done when severe chest injuries are caused by a high-speed motor vehicle crash or a fall from a height.

Treatment

  • Control of heart rate and blood pressure

  • Surgery to repair the aorta or insertion of a wire mesh

The first priority is to control the person's heart rate and blood pressure. If blood pressure and heart rate are high, a tear can become worse, sometimes causing the aorta to burst. Drugs, such as beta-blockers, can help control both. Other measures that may help can include giving pain relievers, trying to keep the person calm, and refraining from doing procedures that may cause gagging or vomiting.

After heart rate and blood pressure are controlled, surgery is done to repair the tear. Sometimes doctors place a mesh tube (stent) into the aorta to cover the tear.

* This is the Consumer Version. *