Definition
A complete tear in the wall of the aorta is called an aortic rupture. An aortic rupture is extremely rare and must be surgically treated as soon as possible, otherwise it is absolutely fatal. Even a small tear in the aorta leads to massive bleeding into the body within a very short time. A rupture of the aorta can occur either due to progressive changes in the vessel wall (e.g. arteriosclerosis) or as a result of blunt trauma.
Cause
A distinction is made between spontaneous aortic rupture and traumatic aortic rupture. A spontaneous aortic rupture can occur if the aorta is already damaged by a pre-existing aneurysm (arterial bulging) or an aortic dissection (aortic splitting). The wall of the aorta consists of three layers: an inner layer of vascular cells (intima), a middle muscle layer (media) and an outer layer of connective tissue (adventitia).
An aneurysm causes these three vascular layers to bulge, i.e. the blood vessel expands. This is often caused by chronic damage to the vessel wall through the deposition of arteriosclerotic plaques (arteriosclerosis) and high blood pressure (arterial hypertension). If the sacculation becomes too large, the wall layers can tear completely and the aorta is ruptured.
In the case of an aortic dissection, a tear causes the individual layers of the wall to split and subsequent bleeding between the layers. Normally, blood from the aorta flows only along the innermost layer, the intima. The blood then splits between the media and adventita, causing the aorta to expand and rupture completely (aortic rupture).
A traumatic aortic rupture can result from blunt force applied to the thorax. In most cases, accidents at high speed (e.g. car accidents, falls from great heights or head-on collisions) cause an impact to the thorax. In such an impact, extreme shear forces act on the vessels, which can cause the aorta to rupture.
Diagnosis
An aortic rupture is an absolute emergency that must be treated as quickly as possible. During the physical examination, the doctor will note, in addition to severe chest pain, a difference in blood pressure between the arms and legs or between the arms. In addition, the skin of the lower half of the body may appear paler due to the lack of blood supply. Other signs are reduced breathing sounds and unconsciousness. If an aortic rupture is suspected, the diagnosis must be confirmed immediately by imaging procedures such as X-ray, ultrasound or computer tomography (CT).
Indications
Signs of a spontaneous aortic rupture may be a sudden, rupturing pain in the chest area, which is characteristically described as a deep-seated pain of destruction. Depending on the location of the rupture, blood pressure loss and neurological symptoms such as loss of sensitivity and paralysis may occur. The rupture of the aorta results in massive blood loss to the chest or abdomen.
The blood loss causes a rapid drop in blood pressure, which means that the oxygen supply to the brain can no longer be guaranteed. As a result, the patient often loses consciousness and faints. The interruption of the body’s constant blood supply can also lead to a reduced supply to other organs, which then no longer receive enough oxygenated blood and are damaged.
Traumatic aortic rupture usually involves further severe injuries to the internal organs (polytrauma). As a routine procedure, a CT scan is performed as part of the shock room treatment in polytraumatic patients. A dislocation of the trachea and esophagus as well as a blurred contour of the aorta can be signs of an aortic rupture. Due to heavy bleeding into the chest or abdomen, a pronounced haematoma next to the aorta can also be detected.
