Thoracic aortic rupture in patients with multisystem injuries.

This report attempts to delineate management priorities in patients with thoracic aortic tears and severe multisystem trauma. Nineteen patients with a mean age of 40 years were treated after motor vehicle accidents. An average of five major systems were injured and the majority of patients sustained head injury, severe intra-abdominal injuries, and major fractures, in addition to aortic tears. Hypotension was present in 17 patients. Chest roentgenograms showed a widened mediastinum that subsequently led to angiography in 18 of the 19 patients. Of the 11 patients who required both an exploratory laparotomy for control of intra-abdominal hemorrhaging as well as a thoracotomy for the transected aorta, only four survived. Ten of 19 patients died of combined aortic and severe multisystem injuries. Death was caused by exsanguination in five patients, contusion in two, and by sepsis, head injury, and acute tamponade, respectively, in the remaining three patients. This review documents the need for aggressive aortography in patients with suspected thoracic aortic injuries. Procedural priorities have been outlined for treatment of patients with severe combined injuries to the abdomen and chest.