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Aortic Rupture, Traumatic (Tai)

Aortic Rupture, Traumatic (Tai) is a topic covered in the 5-Minute Emergency Consult.

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  • Traumatic aortic rupture (also referred to as traumatic aortic injury or TAI) is the cause of death in an estimated 20% of lethal motor vehicle collisions.
  • An estimated 85% of patients with TAI die before reaching the hospital.
  • Patients surviving to the ED usually have a contained rupture as aortic blood is tamponaded by the adventitia.
  • Without proper treatment, of the 15% that survive the initial event, 49% will die within the 1st 24 hr, and 90% within 4 mo.
  • Mean age of patients sustaining aortic rupture is 33 yr, and 70% are male.
  • Most tears are transverse, not longitudinal.
  • Tears may be partially or completely circumferential.


  • Most commonly results from motor vehicle collisions >30 mph
  • Unrestrained passengers, driver seat occupants (injuries from steering column and instruments), and ejected occupants.
  • Other mechanisms: Auto versus pedestrian, airplane crashes, falls from height >10 ft, crush and blast injuries, direct blow to chest
  • Proposed mechanisms of aortic injury:
    • Shear forces arising from unequal rates of deceleration of the relatively fixed descending aorta and the more mobile arch
    • “Bending” stress at the aortic isthmus may cause flexion of the aortic arch on the left mainstem bronchus and pulmonary artery.
    • Twisting of the arch forces it superiorly and causes it to stretch.
    • Osseous structures (e.g., medial clavicles, manubrium, 1st rib) cause pinching of the trapped aorta as they strike the vertebral column.
    • “Waterhammer” fluid wave causes explosive rupture of aorta just distal to the aortic valve.

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Rosen, Peter, et al., editors. "Aortic Rupture, Traumatic (Tai)." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307282/all/Aortic_Rupture__Traumatic__Tai_.
Aortic Rupture, Traumatic (Tai). In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307282/all/Aortic_Rupture__Traumatic__Tai_. Accessed April 25, 2019.
Aortic Rupture, Traumatic (Tai). (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307282/all/Aortic_Rupture__Traumatic__Tai_
Aortic Rupture, Traumatic (Tai) [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 25]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307282/all/Aortic_Rupture__Traumatic__Tai_.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Aortic Rupture, Traumatic (Tai) ID - 307282 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307282/all/Aortic_Rupture__Traumatic__Tai_ PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -