Occult ascending aortic rupture in the presence of an air bag

A patient presented to the emergency department after a high-speed decelerating-type motor vehicle accident. Due to activation of his air bag device, the patient was without significant obvious injury. Upon evaluation in the emergency department he was also without any radiographic or physical signs of serious injury. In the ensuing 24 hours, severe chest pain developed, and subsequent aortography demonstrated a tear of his ascending aorta just distal to the root. Although occult injury to the aorta and great vessels does occur in a small percentage of patients, it is quite rare. However, with the advent of air bags, in the absence of associated injuries, signs, and symptoms, a high index of suspicion must be entertained in decelerating-type accidents to diagnose occult injury to the aorta and great vessels.