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 Dx and Management of Rupture of Aorta  



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Author10 Posts
  #1

Dx and Management of Rupture of Aorta.....

FIRST TEST:
1. CXR to check for widening of mediastinum (not always present in aortic rupture, but absence of widening doesn't rule out rupture either)......so......

Whether or not CXR shows anything, NEXT STEP:
2. SPIRAL CT (aka Helical CT)

If CT POSITVE ---> go to OR -surgical treatment

If CXR POSITIVE and CT Negative --> Next step
3. Arteriogram/Aortogram

BUT what if BOTH CXR AND CT are NEGATIVE???
Do we stop here, or do we still do Arteriogram/Aortogram???





  #2

i think we should still do the definitive test which is an aortogram.sometimes CXR and spiral CT both miss it.and we dont want to miss thoracic aorta rupture.


  #3

nod


  #4

Also consider TEE ( Transoseophageal echocardiography)


  #5

multifactorial wrote:
i think we should still do the definitive test which is an aortogram.sometimes CXR and spiral CT both miss it.and we dont want to miss thoracic aorta rupture.


I was reviewing this again, and this is the management if you suspect transection of the aorta -(you should suspect it in major trauma especially when there was trauma to hard to break bones like the clavicle, first rib or scapula. OR when there was a major deceleration like in MVA)

CXR- and CT- ---> No further work up
CXR + and CT- ---->do Angiogram/Aortogram
CXR -/+and CT+ ----> Go to OR and repair.





Edited by DrVirgo on Apr 08, 2008 - 11:44 AM

  #6

its great:

you can add this to your notes.



Very first step: Give Anti HTN. viz IV ESMOLOL or IV - LABETOLOL

next: CXR

next : 2 options : CT or TEE

CT is preffered

indictaions of TEE:

when the patient is too unstable and can not leave for CT scan b) Can not tolerate contrast of CT scan
( TEE is done @ bed side )

they are equally good though. If we have a diagnosis by going this far. proceed with surgery

if still in doubt do an angiogram ( gold standard )





  #7

2 more points:
What do you do for a pulsatile abdominal mass?

Below how many cm is the cut off for -Observation
How many cm above need -Elective repair



  #8

best screening test for pulsatile mass is ultrasound ( AAA ) not CT or MRI.

I am not sure about the cut offs. but AAA is also treated as an elective procedure so there has to be a cutt off for emergency vs elective



  #9

What do you do for a pulsatile abdominal mass? -Sonogram and elective surgical repair.
BUT if it is TENDER, and pulsatile, it is ready to rupture, so IMMEDIATE surgery is necessary.

Below how many cm is the cut off for -Observation -below 4cm.
How many cm above need -Elective repair -above 6cm.



  #10

Thanks smiling face






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