In the ascending aorta (the portion of the aorta which is almost vertical), one mechanism of injury is torsion (a two-way twisting).[1] There are clinical predictors of an aortic injury.[6] The predictors include if a patient is older than 50, was an unrestrained patient, has hypotension, has a thoracic injury requiring thoracotomy, has a spinal injury, or has a head injury.[6] If four of these criteria are met their likelihood for an aortic injury is 30%[6]