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Evaluation of possible traumatic thoracic aortic injury using aortography and CT
M N Fenner1, K S Fisher, N L Sergel
1Department of Surgery, Southern Illinois University School of Medicine, Springfield.
Insights
Computed tomography (CT) is a sensitive and accurate screening tool for traumatic aortic rupture, often negating the need for aortography in stable patients with widened mediastinum.
Area of Science:
- Radiology
- Trauma Surgery
- Diagnostic Imaging
Background:
- Traumatic aortic rupture is a life-threatening injury.
- Evaluation methods for suspected aortic injury require careful comparison.
- Widened mediastinum on chest x-ray is a common indicator for further investigation.
Purpose of the Study:
- To compare the diagnostic accuracy of computed tomography (CT) and aortography for traumatic aortic rupture.
- To evaluate CT as a screening tool for aortic injury.
- To determine the effectiveness of imaging modalities in identifying aortic disruption.
Main Methods:
- Retrospective review of 1,031 trauma charts (1983-1989).
- Evaluation of 59 patients with suspected aortic injury.
- Comparison of CT scans and aortograms, including combined imaging in some cases.
Main Results:
- CT demonstrated 100% sensitivity for aortic injuries versus 75% for aortography.
- CT had a 3.8% false positive rate and 96% specificity.
- Aortography had a 7.7% false positive rate and 92% specificity, with more inaccurate studies overall.
Conclusions:
- CT is a highly sensitive and accurate screening tool for traumatic aortic rupture.
- CT can successfully identify aortic injuries, often eliminating the need for aortography in stable patients.
- The study recommends CT for evaluating widened mediastinum in trauma patients.
Abstract:
To identify and compare the methods of evaluation for suspected traumatic aortic rupture, 1,031 trauma charts from 1983-1989 were reviewed. Fifty-nine patients were evaluated for possible aortic injury. Patients who died before completion of the CT or aortogram were excluded. Widening of the mediastinum on chest x ray was the most frequent indication for follow-up studies. Twenty-five had a CT of the aortic arch alone. No study showed disruption. There were no false negative studies. Thirty patients had only aortography. Twenty-four were read as normal (one false negative). Six were read as positive (one false positive). In four, both studies were performed (CT/aortography--TP/TP, TN/TN, TP/FN, FP/FP). (FP = False Positive, TP = True Positive, FN = False Negative, TN = True Negative.) Six received surgical repair of the aortic injury (one death). In this experience, CT was used successfully as a screening tool for aortic disruption. It was highly sensitive in recognizing aortic injuries when present (100% vs. 75% for aortography) and in most cases did not require aortographic verification. False positive rates were comparable (CT = 3.8%, aortography = 7.7%). Specificity was also comparable (CT = 96%, aortography = 92%). Overall, four aortograms were inaccurate while only one CT was inaccurate. We recommend the use of CT for the evaluation of widened mediastinum in the stable patient.