Traumatic dissecting aneurysms.

Most dissecting aneurysms of the aorta are spontaneous, and have as their underlying pathology a degeneration of the media. Strain, physical and mental, has been suggested as a factor which precipitates their onset, but external trauma is usually exonerated. Shennan (1934) traced only six cases due to trauma, and he formed the opinion that there was rarely a clear relationship between these aneurysms and external trauma. When Mote and Carr (1942) reviewed 60 cases of dissecting aneurysm investigated in the San Francisco Coroner's Office, they concluded that external trauma was not a precipitating factor. Subsequent reviews, such as those of Gore (1952), Gore and Seiwert (1952), and Graham and Milne (1952), omit any mention of this factor. This belief that dissecting aneurysms arise independently of external violence is wrong. Some dissecting aneurysms are precipitated bv trauma and they have features which appear to differentiate them from the spontaneous kind. An awareness of these features will show that these aneurysms are not as rare as was previously supposed. The following three cases occurred in Leeds during the last two and a half years.