List risk factors.
Large aneurysm diameter
Rapid aneurysm expansion
Trauma
Smoking
List clinical features.
Contained rupture
Severe chest pain (may be indistinguishable from acute MI)
Possible abdominal pain in patients with thoracoabdominal aneurysms
Patients are often hemodynamically stable.
Free rupture
Possible loss of consciousness
Severe chest and possible abdominal pain
Hypotension
Acute respiratory failure
Hemoptysis
Gastrointestinal bleeding
Cardiac tamponade and cardiogenic shock
Cardiac arrest (secondary to profound hypovolemia)
Describe the initial evaluation.
Hemodynamically unstable patients: no time for detailed assessment
Proceed directly to OR; POCUS or formal bedside TTE may be considered if it does not delay treatment.
Hemodynamically stable patients: Obtain CTA of the chest, abdomen, and pelvis with IV contrast.
Supportive findings
Extravasation of contrast
Contained rupture: perivascular hematoma sealed off by surrounding structures
Free rupture: massive hematoma
List additional diagnostic evaluations to consider.
ECG: to rule out STEMI as a differential diagnosis
Laboratory studies: There are no laboratory findings specific to TAA rupture.
CBC: ↓ hemoglobin, ↓ hematocrit, and ↓ red blood cell count in severe hemorrhage
ABG: metabolic acidosis in cases of shock
See “Chest pain” for workup and differential diagnoses.
Describe the treatment, complications and prognosis.
Emergency surgical repair
OSR
TEVAR may be considered in patients with rupture of the descending thoracic aorta. [17]
Bleeding into the mediastinum → cardiac tamponade (rapidly fatal)
Left hemothorax
Free rupture has a high mortality rate.
Last changeda year ago