Rupture of the ascending aorta caused by blunt trauma.

BACKGROUND: Rupture of the ascending aorta caused by blunt trauma rarely has been diagnosed and treated. As a result, the clinical manifestations and management of this injury have not been clearly defined. METHODS: We describe the clinical presentation, diagnosis, and management of 3 consecutive patients with ascending aortic rupture treated during the last 3 years. We also review the cases with this injury reported in the English-language literature until 1996. RESULTS: The predominant clinical manifestations of all patients, including reviewed case reports, were those of other organ injuries, and 5 had signs of aortic regurgitation and 1 of cardiac tamponade. The mediastinal silhouette was normal in 6 and widened in 14 patients, 1 of whom had also rupture of the subclavian artery. The aortic tears were managed with primary repair or with graft interposition and the valve injury with replacement or repair. Three of 20 patients died, for an overall mortality of 15%. CONCLUSIONS: Ascending aortic rupture should be considered in any patient with severe blunt trauma who has widened mediastinum or cardiac tamponade, as well as in patients with associated major thoracic injuries. Absence of a widened mediastinal silhouette does not exclude the diagnosis. The repair is relatively straightforward, but survival depends primarily on the severity of associated injuries.

Missiles in the cardiovascular system.

A missile in the cardiovascular system is a rare complication of a projectile wound. A missile in the heart should be suspected in the patient with a projectile wound of the thorax and in whom, on chest radiography, a missile is seen in the cardiac silhouette. A missile should be suspected in the patient with a projectile wound elsewhere with similar radiographic findings, no exit wound, and no missile in the area of injury. A missile in the arterial system should be suspected when no exit wound and no projectile are seen in the traumatized area. In such a case, radiography of the entire body should be done. The diagnosis of a suspected missile in the cardiovascular system is confirmed by echocardiography or angiography. Treatment should be individualized according to the clinical manifestations of the patient and the site of the missile.

Autotransfusion from experimental hemothorax: levels of coagulation factors.

The coagulation system was investigated in five dogs undergoing autotransfusion from experimental hemothorax. One fourth of the blood volume was bled into the pleural space, drained, and autotransfused. The hemothorax blood showed: very prolonged PT and PTT; very low platelets and fibrinogen; midly elevated FDP; very low coagulation factors VIII, and V; reduced XII, prothrombin, X, XI, and VII. Partial clotting, mild fibrinolysis, and fibrin deposition over the pulmonary pleura seemed to cause incoagulability of hemothorax blood. Post autotransfusion arterial blood showed: normal PT and PTT; 25% decrease in platelets, and 31% decrease in fibrinogen from baseline values. There was also an overall 20% reduction of fibrinogen from baseline values. There was also an overall 20% reduction of all clotting factors, but their levels remained above 50% activity. It was concluded that autotransfusion from a hemothorax of 25% the blood volume in dogs causes a mild loss of hemostatic components, but does not significantly compromise the clotting mechanism.