Radiologic evaluation of blunt thoracic aortic injury in pediatric patients

The objective of our study was to assess the mechanism of injury, associated injuries, and radiographic findings of pediatric patients presenting with blunt thoracic aortic injury.

The medical records and imaging studies of all pediatric patients presenting with blunt thoracic aortic injury from January 1986 through December 2007 (n = 17) were reviewed. The mechanism of injury, associated injuries, imaging findings, and surgical findings were recorded. The Fisher's exact test was used to assess changes in utilization of chest CT and thoracic aortography.

The most frequent mechanism of injury was motor vehicle crash in which the patient was an unrestrained driver or unrestrained passenger (9/17 = 53%). The most common concurrent injury was solid abdominal organ injury (9/17 = 53%). The most frequent finding was a prominent or indistinct aortic knob (16/17 = 94%) on chest radiography, a periaortic hematoma and aortic contour abnormality on chest CT (9/10 = 90%), and aortic contour abnormality on thoracic aortography (11/11 = 100%). There was a statistically significant increase (p = 0.03) in chest CT examinations performed between January 1986 and December 1997 (4/9 = 44%) compared with between January 1986 and December 2007 (8/8 = 100%). There was a statistically significant decrease (p = 0.05) in thoracic aortography examinations performed between January 1986 and December 1997 (8/9 = 89%) compared with between January 1986 and December 2007 (3/8 = 38%).

Blunt thoracic aortic injury is a rare injury in the pediatric population. Radiologic evaluation of pediatric patients presenting with this injury has changed. More chest CT examinations and fewer thoracic aortography examinations are being performed. Furthermore, surgeons are choosing to perform surgery on the basis of chest CT findings consistent with aortic injury.