Overview
Traumatic rupture of the thoracic intervertebral disc is not directly addressed in the provided abstracts, which focus primarily on thoracic aortic injuries following blunt trauma. However, thoracic trauma can involve multiple organ systems, including the aorta, diaphragm, and lungs, complicating diagnosis and management.Diagnosis
Clinical Signs: Hypotension, upper extremity hypertension, bilateral lower extremity pulse deficits, significant chest tube output >750 ml 3.
Radiographic Findings: Mediastinal widening (≥8 cm), nasogastric tube deviation to the right, esophageal displacement (nasogastric tube to the right), mediastinal contour abnormalities, aortopulmonary window opacification 57.
Diagnostic Imaging: Chest radiography followed by intraarterial digital subtraction angiography (IA-DSA) for definitive diagnosis 45.
Additional Injuries: Consider diaphragmatic hernia, intra-abdominal injuries, and pulmonary emphysema bullae in the context of thoracic trauma 1.Management
Emergency Aortography: IA-DSA recommended for suspected aortic rupture due to its accuracy and efficiency 4.
Surgical Intervention: Required for aortic rupture and other significant injuries identified intraoperatively, such as diaphragmatic hernias and pulmonary bullae 1.
Supportive Care: Management of hemodynamic instability with fluid resuscitation and potential vasopressors; monitoring for associated injuries 3.Special Populations
Pregnancy: Not specifically addressed in the abstracts provided.
Pediatrics: Not specifically addressed in the abstracts provided.
Elderly: Increased risk of multiple injuries and complications; thorough evaluation for concomitant thoracic and abdominal injuries is crucial 1.
Comorbidities: Patients with pre-existing conditions may have altered presentation and response to trauma; careful assessment for additional injuries is essential 13.Key Recommendations
Perform chest radiography with attention to mediastinal widening and nasogastric tube displacement for suspected thoracic aortic rupture (Evidence: Moderate 57).
Utilize intraarterial digital subtraction angiography for definitive diagnosis and management planning in patients with high suspicion of aortic injury (Evidence: Strong 4).
Conduct thorough surgical exploration in cases of thoracic trauma to identify and repair multiple injuries, including diaphragmatic hernias and pulmonary bullae (Evidence: Expert opinion 1).References
1 Luciani N, Lapenna E, De Bonis M, Pirronti T, Possati GF. Simultaneous surgical treatment of chronic post-traumatic aneurysm of the thoracic aorta, diaphragmatic hernia and giant emphysema bulla. The Journal of cardiovascular surgery 2002. link
2 Ben-Menachem Y. Rupture of the thoracic aorta by broadside impacts in road traffic and other collisions: further angiographic observations and preliminary autopsy findings. The Journal of trauma 1993. link
3 Kram HB, Wohlmuth DA, Appel PL, Shoemaker WC. Clinical and radiographic indications for aortography in blunt chest trauma. Journal of vascular surgery 1987. link
4 Mirvis SE, Pais SO, Gens DR. Thoracic aortic rupture: advantages of intraarterial digital subtraction angiography. AJR. American journal of roentgenology 1986. link
5 Woodring JH, Dillon ML. Radiographic manifestations of mediastinal hemorrhage from blunt chest trauma. The Annals of thoracic surgery 1984. link60311-6)
6 Wales LR, Morishima MS, Reay D, Johansen K. Nasogastric tube displacement in acute traumatic rupture of the thoracic aorta: a postmortem study. AJR. American journal of roentgenology 1982. link
7 Tisnado J, Tsai FY, Als A, Roach JF. A new radiographic sign of acute traumatic rupture of the thoracic aorta: displacement of the nasogastric tube to the right. Radiology 1977. link