CT evidence for the "osseous pinch" mechanism of traumatic aortic injury.

Abstract

Our prior experiments suggested that traumatic laceration of the aorta induced by rapid deceleration results from pinching of the aorta between the spine and the anterior bony complex (manubrium, clavicle, and first rib). This study examines that hypothesis with in vivo CT data. In 22 patients with angiographically and surgically proved lacerations of the proximal descending aorta, chest CT scans were obtained before (18) or after (four) surgical repair. The point of impact of the anterior bony complex with the anterior surface of the thoracic spine during compression of the thorax was predicted by simulated rotation of the first rib based on calculations made from the CT scans. In all 22 patients, the projected site of impact of the anterior bony complex with the spine corresponded to the actual injured aortic segment as determined with angiography. Our data further support the proposed "osseous pinch" mechanism of injury to explain traumatic tears of the aorta.