Traumatic rupture of the thoracic aorta in childhood with special reference to the therapeutic strategy

European Journal of Pediatric Surgery : Official Journal of Austrian Association of Pediatric Surgery ... [et Al] = Zeitschrift Für Kinderchirurgie
H StriffelerU Althaus

Abstract

Acute traumatic tear of the thoracic aorta is extremely rare in childhood. Based upon our own experience with two children, the essential diagnostic and therapeutic measures are discussed with special reference to timing of surgery. Aortic disruption must be suspected in a child who sustains severe blunt chest injury and develops an abnormally wide mediastinum. Definite diagnosis is established by aortography or computed tomography. The appropriate therapeutic approach is determined by the clinical symptomatology and particularly by the severity of concomitant lesions. In the absence of a significant hemothorax and if no difference in pulse amplitude between upper and lower extremities is evident, the risk of free aortic rupture with intrathoracic exsanguination is presumed to be rather low if the patient reaches the hospital alive. In that situation, the continuity of the injured aorta is maintained by the adventitia and surrounding mediastinal structures. Therefore, these patients may derive the best benefit from an initially conservative management including pharmacological intervention to reduce the risk of free aortic rupture. This concept is particularly indicated if aortic disruption is associated with severe concomitant...Continue Reading

Citations

May 4, 2005·The Journal of Thoracic and Cardiovascular Surgery·H RousseauP Otal
May 9, 2003·The Annals of Thoracic Surgery·Riyad Karmy-JonesRobert D Bloch
Sep 1, 1996·The Annals of Thoracic Surgery·G D TrachiotisF M Midgley
Apr 21, 2004·Current Problems in Surgery·Riyad Karmy-Jones, Gregory J Jurkovich

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