<unk> es to the<unk>  are usually the result of trauma, such as deceleration and crush<unk> es. Deceleration<unk> es almost always occur during high speed impacts, such as those in motor vehicle crashes and falls from a substantial height. Several mechanical processes can occur and are reflected in the<unk>  itself. A more recently proposed mechanism is that the<unk>  can be compressed between bony structures (such as the manubrium, clavicle, and first rib) and the spine. In the ascending<unk>  (the portion of the<unk>  which is almost vertical), one mechanism of<unk>  is torsion (a two-way twisting). There are clinical predictors of an<unk> c<unk> . The predictors include if a patient is older than 50, was an unrestrained patient, has hypotension, has a<unk><unk>  requiring thoracotomy, has a spinal<unk> , or has a head<unk> . If four of these criteria are met their likelihood for an<unk> c<unk>  is 30% The<unk> c wall is made up of three different components the inner layer (intima), the muscle layer (media), and the outer layer (adventitia). A traumatic<unk>  to the<unk><unk>  can cause disruption of any of these parts. Therefore,<unk> c<unk>  is on a scale from<unk>  to a part of the inner layer to a complete tear of all three layers. There are 4 grades of<unk> c<unk> . * Type I: Intimal tear * Type II: Intramural hematoma * Type III: Pseudoaneurysm * Type IV: Rupture In addition to the 4 grades of<unk> c<unk> , the risk of rupture can also be categorized. If both the inner layer and the muscle layer of the<unk> c wall are both involved in the<unk>  then the<unk>  is categorized as significant<unk> c<unk> . If just the inner layer and a portion of the muscle layer are involved in the<unk>  then the<unk>  is characterized as minimal<unk> c<unk> . Radiographically this would be seen as an intimal flap less than 1 cm in size. Between the mobile ascending<unk>  and the relatively fixed descending<unk><unk>  is the<unk> c isthmus. When there is a sudden deceleration the mobile ascending<unk>  pushes forward creating a whiplash effect on the<unk> c isthmus. However, a different mechanism is involved when the ascending<unk>  proximal to the isthmus is torn. When there is a rapid deceleration the heart is pushed to the left posterior chest. This causes a sudden increase in intra-aortic pressure and can cause<unk> c rupture. This is known as the water hammer effect. Based on the location of the<unk>  in the thorax subsequent<unk> es can take place. If the<unk>  is in the descending<unk><unk>  this could lead to a hemothorax. Where as an<unk>  to the ascending<unk>  could lead to hemoperricardium and subsequent tamponade or could compress the SVC.
Thoracic aorta injury
Traumatic aortic rupture
Diaphragmatic rupture
Esophageal rupture
Pulmonary contusion
Right heart strain
Pulmonary laceration
Pulmonary hematoma