Deceleration injuries almost always occur during high speed impacts, such as those in motor vehicle crashes and falls from a substantial height.

A more recently proposed mechanism is that the aorta can be compressed between bony structures (such as the manubrium, clavicle, and first rib) and the spine.

When there is a sudden deceleration the mobile ascending aorta pushes forward creating a whiplash effect on the aortic isthmus.

[9] Clinical signs are uncommon and nonspecific but can include generalized hypertension due to the injury involving the sympathetic afferent nerves in the aortic isthmus.

There are several terms which are interchangeably used to describe injury to the aorta such as tear, laceration, transection, and rupture.

This method involves inserting a catheter into the aorta and directly injecting contrast material.

The primary benefit of aortography is the ability to precisely determine the location of injury for surgical planning.

Since a CT angiogram has a sensitivity of 100% and less invasive due to the peripheral placement of the IV line than aortagraphy it is the primary imaging choice.

[4] A chest X-ray can also be useful to diagnose subsequent problems caused by aortic rupture such as pneumothorax or hemothorax.

[9] Non contrasted CT scans might show an intimal flap, periaortic hematoma, luminal filling defect, aortic contour abnormality, pseudoaneurysm, contained rupture, vessel wall disruption, active extravasation of intravenous contrast from the aorta and is therefore useful to assess for minimal aortic injury.

[9] Trans esophageal echos are useful in patients that are hemodynamically unstable, but the sensitivity and specificity of this study varies based on clinical user.

[9] Endovascular repair is the current gold standard due to increased success rates and lower complications.

[1] Repair should be delayed if there is life-threatening intra-abdominal or intracranial bleeding or if the patient is at risk for infection.

[8] When the surgery is performed a constant check of blood flow to the parts of the body away from the injury should be monitored to know if oxygenation is occurring.

[3] Systolic blood pressure should be maintained between 100 and 120 mmHg allowing for perfusion distal to the injury but decreasing the risk of rupture while the heart rate should be kept under 100 beats per minute.

[8] Thoracic aortic injury is the 2nd leading cause of death involving both blunt trauma.

[10] Of the thoracic aortic injuries the ligament arteriosum is the most common location followed by the portion of the aorta after the origin of the left subclavian artery.

Other mechanisms include airplane crashes, falling from a large height and landing on a hard surface, or any injury that causes substantial pressure to the sternum.