Imaging of thoracic aortic injury

Area of Science:

• Cardiovascular Imaging
• Trauma Surgery
• Radiology

Background:

• Isthmic aortic rupture is a critical, life-threatening injury following high-energy thoracic trauma.
• Rapid diagnosis is essential, but potential diagnostic pitfalls can complicate interpretation.

Purpose of the Study:

• To outline the diagnostic approach for isthmic aortic rupture in trauma patients.
• To detail the primary CT angiography findings and potential diagnostic challenges.

Main Methods:

• Review of CT angiography findings in patients with high kinetic energy thoracic trauma.
• Identification of key imaging signs indicative of aortic rupture or disruption.
• Analysis of common diagnostic pitfalls and associated injuries.

Main Results:

• Key CT signs include periaortic hematoma, intimal flap, pseudoaneurysm, and contrast extravasation.
• Aortic lesions are classified into three types (intimal, subadventitial/pseudoaneurysmal, complete rupture) for grading.
• Diagnostic pitfalls include ductus diverticulum and post-isthmic fusiform dilatation.
• Common associated lesions involve the aortic root and thoracic aorta at the diaphragmatic hiatus.

Conclusions:

• Systematic CT angiography is vital for diagnosing isthmic aortic rupture after thoracic trauma.
• Recognizing specific CT signs and potential pitfalls is crucial for accurate diagnosis and management.
• Grading of aortic lesions and identification of associated injuries are important for therapeutic planning.