A 35-year-old female was involved in a head-on collision motor vehicle accident. If she was found to have a traumatic rupture of the aorta, where along the path of the aorta is the most common site of injury?
1.Ascending aorta
2.Site of attachment of ligamentum arteriosum
3.Aortic isthmus
4.Descending aorta-Thoracic aorta
5.Abdominal aorta
sol:
The aortic isthmus is the most common site of occurrence of a traumatic aortic rupture.
The aortic isthmus is the connection between the ascending and descending aorta. It is the site just distal to where the left subclavian artery branches off the aorta. Traumatic aortic ruptures are commonly caused by decelerating motor vehicle accidents. Other areas of aortic disruption can occur at the cardiac root, the attachment of the ligamentum arteriosum, and the passage through the diaphragm.
Butler et al. discuss post-traumatic stress reactions after motor vehicle accidents (MVAs). Over 3 million people are injured in MVAs each year, and many of these individuals will undergo post-traumatic stress and anxiety regarding the incident. Physicians are in a unique position within society to encourage safe driving habits and seat-belt use in an attempt to reduce vehicle accident trauma.
Mirhosseini et al. report on the surgical management of traumatic rupture of the aortic isthmus. This condition is a surgical emergency with a high mortality rate. Open surgical repair is the standard treatment for the majority of patients. One of the major risks of surgical repair is a postoperative paraplegia secondary to spinal cord ischemia.
Illustration A depicts the anatomic site of the aortic isthmus. Illustration B is a CT scan showing a sagittal oblique view of an aortic transection distal to the left subclavian artery.