Minimal Aortic Injury: Mechanisms, Imaging Manifestations, Natural History, and Management

Area of Science:

• Radiology and Imaging
• Trauma Surgery
• Cardiovascular Medicine

Background:

• Increased utilization of multidetector CT has led to greater detection of minimal aortic injury (MAI).
• MAI is a mild form of blunt traumatic aortic injury (BTAI) typically managed conservatively.
• Traditional MAI imaging findings include small intimal flaps or thrombi (SVS grade I).

Purpose of the Study:

• To review the evolving definition, pathophysiology, and natural history of MAI.
• To present imaging findings, diagnostic pitfalls, and management options for MAI.
• To discuss the potential expansion of the MAI spectrum to include entities like small pseudoaneurysms.

Main Methods:

• Review of current literature on MAI.
• Analysis of imaging findings from multidetector CT.
• Discussion of clinical management strategies.

Main Results:

• MAI, including some SVS grade II and potentially grade III injuries, often shows favorable outcomes with conservative management.
• Injury progression in MAI is rare, with endovascular repair reserved for specific cases.
• Follow-up imaging protocols for MAI lack consensus but often involve repeat CT scans.

Conclusions:

• The definition and management of MAI are evolving, with a trend towards conservative approaches.
• MAI generally has a favorable prognosis, with rare progression.
• Further research may expand the classification of injuries included in the MAI spectrum.