Volume 2 Number 2 DEIRANIYA AND TAYLOR : RUPTURE OF THORACIC AORTA 93 TRAUMATIC RUPTURE THORACIC AORTA A. K. DEIRANIYA and D. G. TAYLOR Cardiothoracic Department, Royal Infirmary, Sheffield OF THE 1. Traumatic aortic rupture is a common, highly lethal injury. Without surgery, post- injury survival is precarious for the majority. A few form so-called ' stable aneurysms '. 2. Early diagnosis rests on constant awareness of the prevalence of this injury in sudden deceleration accidents, and critical appraisal of clinical and radiological signs. 3. Aortography is essential in confirming or refuting the diagnosis. 4. Chronic traumatic asymptomatic aneurysms are liable to complications. Surgical repair is recommended. ROAD traffic accidents are a major cause of morbidity and mortality in developed countries. In Britain, during 1968 6810 people were killed and 88,563 seriously injured in such accidents (Road Accident Statistical Review, 1969). Traumatic rupture of the aorta may occur as the result of a chest injury, most frequently associated with sudden deceleration as in head-on collisions (Rittenhouse, Dillard, Winterscheid, and Merendino, 1969). This paper reports our experience of 3 cases seen at the Royal Infirmary, Sheffield, between 1966 and 1968. All were young males. Two of them were the victims of road traffic accidents and one was injured in a cave-in accident while pot-holing in Derbyshire. CASE REPORTS Case 1 A 19-year-old university student was admitted on 17 Oct., 1966, having been injured while pot-holing in Derbyshire. He was trapped under a fall of rock and extricated 6 hours later. On examination he was conscious. Apart from a few abrasions on his face and chest there was no other external evidence of injury. He was shocked, dysp- noeic, and suffering from exposure. It was noted that the trachea was deviated to the right, he was hyperresonant over the left thorax and the air entry was diminished at the left base. The upper abdomen was tender. A chest radiograph revealed a left pneumothorax. A chest drain was inserted. Air under pressure was released and 500 ml. of blood drained. Laparotomy was undertaken shortly after admission. A ruptured spleen was removed and hepatic lacera- tions sutured. The patient did well after operation, but he had a persistent hypertension of 190/60. A harsh systolic interscapular murmur and diminished femoral pulses were noted on the fourth day. A tentative diagnosis of traumatic rupture of the aorta was made. An aortogram was performed through the left axillary artery. This confirmed the presence of a small aneurysm distal to the left subclavian artery (Fig. 1). Surgery was advised in view of the known tendency of these aneurysms to rupture. Fig. 1.---Aortogram; lateral view showing flattened segment distal to the left subclavian artery, with art oblique translucent lirte at its lower extent (see arrow) consistent with an intimal tear of the aorta (Case 1).