Experience with spiral computed tomography as the sole diagnostic method for traumatic aortic rupture

doi:10.1016/S0003-4975(01)02827-2

The Annals of Thoracic Surgery

Volume 72, Issue 2, August 2001, Pages 495-502

Presented at the Forty-seventh Annual Meeting of The Southern Thoracic Surgical Association, Marco Island, FL, Nov 9–11, 2000.

https://doi.org/10.1016/S0003-4975(01)02827-2 Get rights and content

Abstract

Background. Spiral computed tomographic (CT) scan is an excellent screen for aortic trauma. Traditionally, aortography is performed when injury is suspected to confirm the diagnosis. We hypothesized that it is safe and expeditious to forgo aortography when the spiral CT demonstrates aortic injury.

Methods. Retrospective review of 54 patients undergoing aortic repair from July 1994 to December 1999. Spiral CT was the initial diagnostic study in 52 patients. Pseudoaneurysm or aortic wall defect in the presence of mediastinal hematoma was considered diagnostic. Angiography, initially routine, was later performed only when requested by the surgeon, and for all “nonnegative” studies (periaortic hematoma without detectable aortic injury).

Results. Twenty-six patients underwent angiography before operation (group 1). Nineteen group 1 spiral CTs were unequivocally diagnostic; 7 were nonnegative and angiography was required. Twenty-eight other patients underwent repair based on spiral CT alone (group 2). There was one false-positive result in both groups. There were no unexpected operative findings. Mean time from admission to diagnosis was 5.7 ± 3.4 hours for group 1 and 1.7 ± 1.7 hours for group 2 (p < 0.01).

Conclusions. Operating on the basis of a diagnostic spiral CT is safe and expeditious. Aortography may be reserved for those with equivocal studies.

Section snippets

Material and methods

The records of all patients undergoing repair of a traumatic rupture of the descending thoracic aorta from July 1994 to December 1999 were retrospectively reviewed. The definitive diagnostic study that constituted the basis for the decision to proceed to operation was determined from the chart, the operative records, and the radiology reports. Patients were assigned to two groups. In group 1, the final decision to proceed to operation was based on aortography. Group 1 was divided into two

Results

Fifty-seven patients underwent repair of a traumatic rupture of the descending aorta at the University of Maryland from July 1994 to December 1999. One unstable patient who underwent operation on the basis of the admission chest radiograph (CXR) and 2 patients diagnosed by angiography before transfer to the University of Maryland were excluded from further analysis. In the remaining 54 patients, there were 36 men and 18 women with a mean age of 41 ± 17 years. Associated injuries are as follows:

Comment

There are three major diagnostic issues to consider in the evaluation and management of TAR: (1) What is the safest (least missed injuries and least invasive) and most efficient (quickest, and least expensive) way to screen for TAR? (2) What is the safest (least missed injuries and least invasive) and most efficient (quickest, and least expensive) way to definitively diagnose TAR? (3) Has enough reliable information been assembled regarding the aorta and all other potential bodily injuries to

References (20)

S. Attar et al.
traumatic aortic rupture. recent outcome with regard to neurologic deficit
Ann Thorac Surg
(1999)
M. Mollod et al.
Transesophageal echocardiography in the evaluation of cardiothoracic trauma
Am Heart J
(1996)
S. Ledbetter et al.
Helical (spiral) CT in the evaluation of emergent thoracic aortic syndromes. Traumatic aortic rupture, aortic aneurysm, aortic dissection, intramural hematoma, and penetrating atherosclerotic ulcer
Radiol Clin North Am
(1999)
R.G. Fisher et al.
Diagnosis of injuries of the aorta and brachiocephalic arteries caused by blunt chest traumaCT vs aortography
Am J Roentgenol
(1994)
T.C. Fabian et al.
Prospective study of blunt aortic injuryhelical CT is diagnostic and antihypertensive therapy reduces rupture
Ann Surg
(1998)
J.P. Hunt et al.
Thoracic aorta injuriesmanagement and outcome of 144 patients
J Trauma
(1996)
S.E. Mirvis et al.
Traumatic aortic injurydiagnosis with contrast-enhanced thoracic CT– five-year experience at a major trauma center
Radiology
(1996)
S.E. Mirvis et al.
Atypical results of thoracic aortography performed to exclude aortic injury
Emergency Radiology
(1994)
S.E. Mirvis et al.
Use of spiral computed tomography for the assessment of blunt trauma patients with potential aortic injury
J Trauma
(1998)
L.K. von Segesser et al.
Diagnosis and management of blunt great vessel trauma
J Card Surg
(1997)

There are more references available in the full text version of this article.

Cited by (81)

Diagnosis of blunt thoracic aortic injury with electrocardiogram-gated computed tomography in pediatric patient: A case report
2022, Trauma Case Reports
Citation Excerpt :
This survival rate can increase to more than 80% in patients received appropriate diagnoses and interventions [2,3]. Computed tomography (CT) angiography is a highly sensitive and specific test for thoracic aortic injury, and is the choice of diagnostic test in adult patients [4–7]. The sensitivity of CT for BTAI was reportedly 95% [8,9].
Computed tomography (CT) is a sensitive and specific test for thoracic aortic injury, and is the choice of diagnostic test for adult patients. However, the diagnostic accuracy of conventional CT in pediatric patients has not been elucidated, and the diagnostic strategy has not been clarified. We present the case of an eight-year-old patient who had a thoracic injury, with left open pneumothorax, pulmonary contusion, and multiple left-sided rib fractures. Although the findings on conventional CT were insufficient either to diagnose or deny as having thoracic aortic injury, additional examination using electrocardiogram-gated CT angiography and three-dimensional reconstruction revealed a localized enlarged aortic diameter with an intimal flap. Electrocardiogram-gated CT may be useful for diagnosing thoracic aortic injury in pediatric patients.
Multimodality imaging of diseases of the thoracic aorta in adults: From the American society of echocardiography and the european association of cardiovascular imaging: Endorsed by the society of cardiovascular computed tomography and society for cardiovascular magnetic resonance
2015, Journal of the American Society of Echocardiography
Multi-detector computed tomography imaging of blunt chest trauma
2014, Egyptian Journal of Radiology and Nuclear Medicine
Citation Excerpt :
It is also valuable in the diagnosis of fractures of the thoracic spine, especially at the cervico-thoracic junction, which is difficult to evaluate with conventional radiography. In addition, MDCT has helped to exclude thoracic aortic injury, thereby limiting the number of catheter aortographic examinations (10). The aim of this study was to evaluate the role of multi-detector computed tomography in the assessment of patients with blunt chest trauma.
Chest trauma is a significant cause of mortality and morbidity, especially in the younger population. The purpose of this study was to evaluate the role of multi-detector computed tomography (MDCT) in the assessment of patients with blunt chest trauma.
A prospective study was conducted on thirty (30) patients with blunt chest trauma (21 males and 9 females, aged from 6 to 62 years) and 29 control patients presented with any trauma other than blunt chest trauma (23 males and 6 females, aged from 10 to 68 years) at the Emergency Department, Tanta University Hospital, from January 2013 to February 2014. Cases were subjected to clinical evaluation and radiological assessment of the chest using conventional chest X-ray (CXR) and multi-detector computed tomography.
The most common mode of injury was motor vehicle accidents (56.7%). On MDCT scan, the frequency of chest injuries were; chest wall injuries (86.7%), pleural injuries (80%), parenchymal injuries (56.7%), mediastinal injuries (30%) and finally the dorsal spine injuries (16.7%). MDCT is more sensitive, specific, and accurate than CXR in the assessment of blunt chest trauma and management of patients.
MDCT is the modality of choice for rapid assessment of emergency chest trauma patients, when chest X-ray was inconclusive.
Thoracic Injuries in Children
2011, Pediatric Critical Care: Expert Consult Premium Edition
Thoracic Injuries in Children
2011, Pediatric Critical Care
Current Management of Traumatic Thoracic Aortic Injury
2010, Seminars in Vascular Surgery
Traumatic aortic rupture is a devastating injury that is difficult to manage because of the need to approach aortic repair, often in concert with management of complex associated injuries to nonvascular organ systems. Traditional open repair, while effective in the long-term, is associated with a periprocedural mortality between 10% and 20%, along with a 5% risk of stroke and up to a 5% risk of spinal chord ischemia. The advent of endovascular stent graft repair has allowed single centers to cut periprocedural mortality in half and decrease the risk of major neurologic events to <2%. It is unlikely that a multicenter prospective randomized trial will ever be performed to evaluate these two procedures. However, several large meta-analyses have been published recently, along with a clinical practice guideline from the Society for Vascular Surgery. The purpose of this article is to review the trends and current concepts in the management of traumatic rupture of the thoracic aorta.

View all citing articles on Scopus

View full text

Original article: cardiovascularExperience with spiral computed tomography as the sole diagnostic method for traumatic aortic rupture

Abstract

Section snippets

Material and methods

Results

Comment

Ann Thorac Surg

Am Heart J

Radiol Clin North Am

Diagnosis of injuries of the aorta and brachiocephalic arteries caused by blunt chest traumaCT vs aortography

Am J Roentgenol

Prospective study of blunt aortic injuryhelical CT is diagnostic and antihypertensive therapy reduces rupture

Ann Surg

Thoracic aorta injuriesmanagement and outcome of 144 patients

J Trauma

Traumatic aortic injurydiagnosis with contrast-enhanced thoracic CT– five-year experience at a major trauma center

Radiology

Atypical results of thoracic aortography performed to exclude aortic injury

Emergency Radiology

Use of spiral computed tomography for the assessment of blunt trauma patients with potential aortic injury

J Trauma

Diagnosis and management of blunt great vessel trauma

J Card Surg

Original article: cardiovascular
Experience with spiral computed tomography as the sole diagnostic method for traumatic aortic rupture