Traumatic rupture of the thoracic aorta. An autopsy and histopathological study.

Over the 9-month period 1 March - 30 November 1983, 118 consecutive autopsies were conducted on victims of motor vehicle and train accidents. The thoracic aorta was examined for evidence of contusion, partial tearing or rupture, particular attention being paid to the known usual sites of rupture. All lacerations or disruptions were excised together with a segment of surrounding aortic tissue, and processed, sectioned and examined by conventional light microscopy for the presence and extent of aortic tears. Several findings emerged: (i) in nearly two-thirds of cases there was some degree of aortic disruption; (ii) multiple rather than single tears occurred in 41,2% of the 51 subjects in whom aortic tears were found; (iii) tears of the media occurred in more than 60% of cases, highlighting the involvement of this layer of the aortic wall in traumatic lesions; (iv) there was a high (81,4%) incidence of concomitant multiple injuries; (v) most of the victims (75,4%) were dead on arrival at a medical facility; and (vi) positive blood alcohol levels ranging from 0,04 mg/dl to 0,42 mg/dl were found at autopsy in 80% of the subjects.