Computed tomographic evaluation to exclude traumatic aortic disruption

Traumatic aortic disruption from blunt trauma remains a lethal injury. The role of computed tomographic (CT) scanning in the diagnosis of traumatic aortic disruption (TAD) has been debated and varying results have been reported. We reviewed our experience with 133 consecutive cases of blunt trauma with abnormal findings on chest x-ray films of sufficient concern to require further evaluation for TAD. Of the 105 patients who underwent CT scanning as the initial evaluation, 11 (10%) required aortography (Ao) for diagnosis; seven had TAD. Twenty-eight patients with highly suggestive signs of TAD underwent Ao as the initial diagnostic test; five had TAD. Ten of the 12 patients (83%) undergoing surgical repair had good results; one died of exsanguination at surgery and the other suffered a profound neurologic injury. Follow-up by phone or chart review at 6 months to more than 5 years after injury revealed no late mortalities from unrecognized TAD. We conclude that high quality CT evaluation of patients with worrisome chest x-ray films following blunt trauma can be used to exclude TAD in the majority of cases. Aortography is reserved for cases in which there is a high clinical suspicion of TAD and for those patients in whom TAD cannot be confidently excluded by CT scanning.