The injury usually occurs at the ligamentum arteriosum distal to the left subclavian artery origin. Occasionally chronic aneurysms form in those patients not repaired at the time of the initial injury. Other radiographic signs include the loss of the aortic knob. Patients may also need evaluation based on mechanism of injury alone. Aortography is indicated for any of the above.
Immediate repair is essential with an end to end short segment graft.
Diaphragm injuries occur with penetrating or blunt trauma and herniation can occur early or late. Rarely injured with blunt trauma. Rare with isolated penetrating trauma, i.e. there is a high degree of associated injuries. Mediastinal air and pleural effusion are clues to the diagnosis. Endoscopy and esophagogram, gastrograffin followed by barium, will confirm the diagnosis.