CT angiography in blunt thoracic aortic injury: An evidence-mapped review and structured reporting framework

Blunt thoracic aortic injury (BTAI) is a life-threatening consequence of high-energy deceleration trauma, most often involving the aortic isthmus. Computed tomography angiography (CTA) is the first-line imaging examination in contemporary trauma practice, but interpretation may be complicated by subtle minimal injuries, motion-related pseudo-lesions of the aortic root and ascending aorta, and inconsistent application of available grading systems. This educational review synthesizes the published CTA literature on BTAI and presents a structured reporting and triage framework that aligns lesion characterization with established Society for Vascular Surgery (SVS), Vancouver, and Harborview classification schemes. Representative cases are used to illustrate minimal aortic injury, intramural hematoma, pseudoaneurysm, transection, common interpretive pitfalls, and selected post-thoracic endovascular aortic repair (TEVAR) appearances. We summarize published imaging features that may justify escalation of management, highlight situations in which repeat ECG-gated or high-pitch targeted imaging may reduce false-positive interpretation, and provide a practical checklist for standardized CTA reporting. Rather than proposing a new grading system, this review translates fragmented evidence into a reproducible imaging workflow intended to improve diagnostic consistency, multidisciplinary communication, and management-oriented reporting in patients with suspected BTAI.