title: [Traumatic aortic rupture: diagnosis using biplanar transesophageal echocardiography].
abstract: Acute aortic rupture is a typical consequence of severe blunt chest trauma often associated with rapid deceleration in car accidents. Initial diagnostic findings are often misleading and multiorgan injuries add to the diagnostic complexity; therefore, the natural history of acute rupture is usually fatal during the first 24 h after injury if left untreated. Prompt and simple diagnosis is, hence, of paramount importance for successful treatment of acute aortic rupture. Transesophageal echocardiography, particularly with a biplane or multiplane probe, currently represents the diagnostic tool of choice to meet these criteria; because of its high sensitivity and specificity transesophageal echocardiography will replace aortography as "gold standard" for diagnosis of acute aortic rupture. We report on a 47-year-old woman with severe blunt thoraco-abdominal trauma resulting from a car accident; at hospital admission abdominal injuries were predominant and diagnosis of an acute rupture of the descending thoracic aorta was made only about 18 h after admission using biplane transesophageal echocardiography. Emergency surgical revision confirmed the diagnosis of complete transsection of the descending thoracic aorta immediately after the origin of the left subclavian artery; the site of transsection was surrounded by a large hematoma. Despite successful reconstruction of the descending thoracic aorta by means of graft interposition, a recurrent local bleeding event lead to complete circulatory destabilization and, finally, to the death of the patient.
authors.affiliation: Department für Innere Medizin, Universitätsspital, Zürich, Schweiz.
authors.forename: M
authors.initials: M
authors.lastname: Ritter
authors.forename: R
authors.initials: R
authors.lastname: Stocker
authors.forename: H
authors.initials: H
authors.lastname: Rickli
authors.forename: M
authors.initials: M
authors.lastname: Jakob
authors.forename: L
authors.initials: L
authors.lastname: von Segesser
authors.forename: R
authors.initials: R
authors.lastname: Jenni
mesh_terms: D001019:Aortic Rupture / Q000000981:diagnostic imaging* / Q000601:surgery; D001807:Blood Vessel Prosthesis; D017548:Echocardiography, Transesophageal; D017809:Fatal Outcome; D005260:Female; D006491:Hemothorax / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000601:surgery
vernacular_title: Traumatische Aortenruptur: Diagnose mittels biplaner transösophagealer Echokardiographie.