Correspondence

Aortic Transection Following Air-Bag Deployment

N Engl J Med 1997; 337:573-574August 21, 1997

Article

To the Editor:

Deceleration injury to the thoracic aorta due to high-speed motor vehicle collisions is a well-known phenomenon. Air bags have been shown to decrease the morbidity and mortality associated with high-speed injuries when used in conjunction with lap and shoulder belts.1,2 Air-bag deployment alone has recently been implicated as a cause of clinically significant thoracic injury to unrestrained drivers.2-4 Air bags inflate at a rate of 6 liters per millisecond, generating a velocity that has been measured at 157 to 338 km per hour (98 to 211 miles per hour).5 Injury of the descending thoracic aorta in association with the deployment of an automobile air bag has been reported.3 We report an injury of the ascending thoracic aorta from the deployment of an air bag in a low-speed accident.

An 84-year-old man who was not wearing a seat belt meant to back his car out of the garage, but mistakenly went forward, striking the garage wall head on at less than 16 km per hour (10 miles per hour). The air bag deployed and he was found in the car awake and alert. There was external damage to the vehicle but not internal damage. The patient had maxillofacial trauma and ecchymosis and tenderness of the sternum. A chest roentgenogram obtained while the patient was upright showed a widened mediastinum. Computed tomography revealed a collection of fluid in the anterior mediastinum contiguous to the ascending aorta. The results of aortography were consistent with a disruption of the ascending aorta (Figure 1Figure 1Aortogram Demonstrating Extravasation of Contrast Material (C) from the Ascending Aorta (Ao), a Finding Consistent with the Occurrence of Aortic Transection.). At surgery, a stellate injury that involved 75 percent of the circumference of the ascending aorta was found and repaired. Renal and pulmonary insufficiency developed postoperatively, and the patient died of multiorgan failure about 10 weeks after the accident.

This case suggests that air-bag inflation may cause serious blunt chest trauma and that safe deployment of air bags requires the concomitant use of lap and shoulder restraints. Physicians must maintain a high index of suspicion for injury when evaluating drivers who were not wearing seat belts when air bags deployed, regardless of the speed of the collision.

Brian J. deGuzman, M.D.
Anthony S. Morgan, M.D.
William F. Pharr, M.D.
Saint Francis Hospital and Medical Center, Hartford, CT 06105-1299

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Citing Articles (7)

Citing Articles

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   Pasquale Mastroroberto, Giulio Di Mizio, Federica Colosimo, Pietrantonio Ricci. (2011) Occlusion of Left and Right Coronary Arteries and Coronary Sinus Following Blunt Chest Trauma. Journal of Forensic Sciences 56:5, 1349-1351
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   Chris C. Cook, Thomas G. Gleason. (2009) Great Vessel and Cardiac Trauma. Surgical Clinics of North America 89:4, 797-820
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   Peter H. Lin, Ruth L. Bush, Alan B. Lumsden. (2005) Traumatic Aortic Pseudoaneurysm after Airbag Deployment: Successful Treatment with Endoluminal Stent-Graft Placement and Subclavian-to-Carotid Transposition. The Journal of Trauma: Injury, Infection, and Critical Care 58:6, 1282-1284
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   Yasunori Sato, Tohru Ohshima, Toshikazu Kondo. (2002) Air bag injuries—a literature review in consideration of demands in forensic autopsies. Forensic Science International 128:3, 162-167
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   Michael Grundman, Patrick Delaney. (2002) Antioxidant strategies for Alzheimer's disease. Proceedings of the Nutrition Society 61:02, 191-202
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   Christian Boldin, Gerolf Peicha, Jörg Michael Passler, Hubert Hauser, Michael Riccabona. (2002) Inferior thyroid artery injury due to airbag deployment. Injury 33:3, 283-284
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   Om P. Sharma, Xavier R. Mousset. (2000) Review of Tricuspid Valve Injury after Airbag Deployment: Presentation of a Case and Discussion of Mechanism of Injury. The Journal of Trauma: Injury, Infection, and Critical Care 48:1, 152
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