• Definition: an injury of the thoracic aorta resulting from blunt trauma; most commonly occurs distal to the left subclavian artery in the aortic isthmus (between Aortic arch and descending aorta)
• Etiology: rapid deceleration from blunt trauma (e.g., MVC, fall from height)
• Clinical features: Severity ranges from intimal lesions (e.g., aortic pseudocoarctation) to thoracic aortic rupture.
  • Chest pain
  • Upper back pain
  • Dyspnea, hoarseness and/or stridor
  • Dysphagia
  • Chest wall instability and/or ecchymoses
  • New interscapular murmur
  • Thoracic aortic rupture: signs of hemorrhagic shock (e.g., tachycardia, hypotension) and tearing pain
• Imaging
  • CXR (initial imaging); potential findings include:
    • Left main bronchus depression
    • Tracheal deviation
    • Apical pleural cap
    • Left pleural effusion (hemothorax)
    • Obscuration of the aortic knob
    • Mediastinal widening
  • Definitive imaging
    • CTA chest in hemodynamically stable patients
    • Transesophageal echocardiography