Laceration of the Aorta: An Autopsy Series

Of 145 autopsies on subjects of impact trauma, 35 had lacerations of the aorta located as follows: proximal aorta ( 5 ), isthmus (22), and descending aorta ( 11 ) (three subjects had lacerations of the isthmus and the descending aorta). Four of the five lacerations of the proximal aorta ruptured into the pericardial sac. All lacerations at the isthmus were full thickness. Five were double, parallel, adjacent lacerations, of which only one was circumferential. Three of the 22 also had intimal tears of the descending aorta. One of the 22 lacerations was tamponaded and did not rupture into a body cavity. In eight, rupture and bleeding occurred into both pleural cavities, whereas 12 had rupture only into the left pleural cavity. Fourteen of the 22 had evidence of transient tamponade in the form of a mediastinal hematoma. Of the 11 subjects with lacerations of the descending aorta, one had only intimal tears. The other ten had full thickness lacerations that were located throughout the descending aorta. Four of the ten had more than one aortic laceration. Six of the total 11 had a vertebral dislocation. Three of the ten also had a laceration at the isthmus. Severe wounds of the head and thoracoabdominal viscera other than the aorta were common. Most subjects died at the scene.

Novel to this study are the explicit descriptions of 1) aortic lacerations involving less than the circumference of the aorta, 2) aortic lacerations that are double, and 3) the tendency for double lacerations to be less than circumferential.