[Rational diagnosis of traumatic aortic rupture]

The traumatic aortic rupture has an extremely high spontaneous mortality rate. Important for surviving the trauma is a fast and efficient diagnostic procedure. The suspected diagnosis results from relatively typical criteria in the chest radiograph, especially the continuous widening of the mediastinum. The diagnostic procedure of 26 patients with polytrauma, abnormal chest radiograph and further examinations (intra-arterial digital subtraction angiography [i.a.DSA]: n = 10, contrast-enhanced CT: n = 19, CT and DSA: n = 5) was reviewed. Six patients had an aortic rupture. In 4 patients the diagnosis was confirmed by angiography, in 2 patients by surgery. The specificity was 100% for DSA and 40% for CT. To ensure the suspected diagnosis of a traumatic aortic rupture we therefore primarily recommend angiography. Whenever CT is performed in case of head injury, a CT of the thorax can be added in order to exclude mediastinal bleeding and to reduce the need for angiography.