Aortic rupture

Not to be confused with aortic dissection.

Aortic rupture is the breakage of all walls of the aorta, the largest artery in the body. Aortic rupture is a rare, extremely dangerous condition that is considered a medical emergency.^[1] The most common cause is an abdominal aortic aneurysm that has ruptured spontaneously. Aortic rupture is distinct from aortic dissection, which is a tear through the inner wall of the aorta that can block the flow of blood through the aorta to the heart or abdominal organs.

Aortic rupture
Aorta segments, with thoracic aorta in area marked in green.
Specialty	Vascular surgery, cardiology, emergency medicine
Symptoms	Abdominal pain, flank pain, or back pain
Complications	Shock, anemia
Usual onset	Acute
Causes	Ruptured aortic aneurysm, trauma
Treatment	Surgical repair
Prognosis	Poor
Deaths	Up to 90% of cases

An aortic rupture can be classified according to its cause into one of the following main types:

• Traumatic aortic rupture
• Aortic rupture secondary to an aortic aneurysm^[2]

Signs and symptoms

Patients with an aortic rupture typically present with a sudden onset of severe pain. In ruptures involving the thoracic aorta, patients often experience acute chest pain that may radiate to the back, whereas involvement of the abdominal aorta more frequently results in pain localized to the abdomen, flank, or lower back. The rapid blood loss can lead to signs of shock, such as low blood pressure, rapid heartbeat, pallor, and even loss of consciousness. Because the clinical presentation may overlap with other vascular emergencies such as Aortic dissection—timely diagnosis using imaging modalities (e.g., computed tomography) is critical to initiate appropriate management.^[3]

Causes

Aortic rupture may result from several distinct etiologies. The most common mechanism involves the spontaneous rupture of an aneurysmal aorta; for example, weakening of the vessel wall due to an Abdominal aortic aneurysm or Thoracic aortic aneurysm can ultimately lead to rupture under elevated intraluminal pressure. In addition, aortic rupture may occur following blunt trauma, as seen in Traumatic aortic rupture, where high-energy impacts from vehicle collisions or significant falls produce differential deceleration forces that tear the aortic wall. On rare occasions, iatrogenic injury during medical or surgical procedures can also precipitate aortic rupture.^[4]

Mechanism

Diagnosis

Diagnosis of a ruptured abdominal aortic aneurysm (rAAA) is challenging, with a wrong diagnosis occurring in between 32 and 42 % of cases. Such errors further increase the mortality risk due to incorrect first response and treatment. In cases of misdiagnosis, aortic rupture is often mistaken for ureteric colic and myocardial infarction (MI).^[4]

Differential diagnosis

The primary differential diagnoses include cardiogenic shock, pleural effusion, pulmonary embolism, myocarditis, myocardial infarction,^[5] but may also encompass acute gastritis, appendicitis, diverticulitis, gallstones, peptic ulcer disease and urinary tract infection as well.^[1]

Prevention

Further information: Aortic aneurysms § Prevention

Treatment

Prognosis

An aortic rupture is a catastrophic medical emergency. People rarely survive such an injury. Mortality from aortic rupture is up to 90%. 65–75% of patients die before they arrive at the hospital and up to 90% die before they reach the operating room.^[6]