Blunt Injury to the Aorta, Esophagus, and Diaphragm

Abstract

Blunt injury to the aorta, diaphragm, and esophagus are unusual and are typically the result of a significant transfer of energy and hence are typically accompanied by other injuries. The associated injury can detract attention, leading to lethal delays in the recognition of blunt injury to the aorta, esophagus, and diaphragm. Improved cross-sectional imaging techniques (CT scanning) and a better understanding of the subtle signs of blunt injury to the aorta, diaphragm, and even esophagus has lessened, but not eliminated, the delay in diagnosis. Changes in management of aortic injuries continue to involve, largely stimulated by the more widespread application of endovascular techniques, and a better understanding of the natural history of less severe grades of injury. Early and primary repair of an acute blunt diaphragm injury remains the standard. Blunt esophageal injury, perhaps the rarest in this category, can largely be excluded on the basis of a detailed thoracic CT scan, although the role of esophageal endoscopy or esophagography remains essential diagnostic tools. The management of these rare injuries is often controversial. This review will examine the recent literature regarding these uncommon injuries, emphasizing recent clinical trials and guidelines.