PATHOLOGISTS have long been aware that a severe 'closed' injury to the chest may cause rapid death through rupture of one of the chambers of the heart or one of the major arteries in the mediastinum. Nowadays the most usual victim is the driver of an automobile or motor-cycle involved in a high-speed road accident.
Kulowski (1960) quotes a report (from the U.S.A.F. Institute of Pathology) of 275 post-mortem cases of aortic rupture following non-penetrating injury to the chest. The site of rupture was in the ascending aorta in 64 cases; the arch in 22; the isthmus in 124; the thoracic aorta in 35; abdominal aorta in 13; and multiple sites in 17 cases. Of the 275 cases of aortic rupture 36 per cent had minimal or no external evidence of chest injury, despite a high incidence of rib fracture.
Gissane and Bull (1961)~ in a study of 344 necropsy reports on fatal road accidents in and around Birmingham, found 26 cases of traumatic rupture of the heart and/or great vessels. Motorcyclists were the most frequent victims in their series; injuries to the heart or great vessels occurred in I I of the 66 motor-cyclist necropsies studied.
Strassman (1947) found 72 cases of ruptured aorta in 7000 consecutive autopsies in New York. The rupture was situated at the isthmus in 40 of these cases. He stated then: "The reason that traumatic rupture of the aorta is not better known lies in the fact that the lesion is discovered only at autopsy." However, a study of the literature of the last ten years or so shows that this statement is no longer true.