[Traumatic rupture of thoracic aorta: review of a 10-year experience]

We retrospectively reviewed the diagnostic imaging examinations of 22 patients affected with traumatic rupture of the thoracic aorta acquired in a 10-year period. Our study was aimed at investigating if the diagnostic approach to these patients has changed in the last 10 years, especially relative to the extensive use of Computed Tomography (CT). All the patients in our series were submitted to chest radiography and aortography; only 15 of them were submitted also to CT. Plain radiography showed enlarged mediastinum and altered aortic profiles in 22/22 patients, rightward deviation of the trachea and nasogastric tube with downward displacement of the left mainstem bronchus and apical cap in 7/22 patients and associated pleuropulmonary injuries in 11 patients. CT image quality was poor because of artifacts in 5 patients, while it demonstrated mediastinal hematoma in 10 patients and associated aortic outline alterations in 5 patients. Aortography always showed the site and number of aortic ruptures. In our experience, aortography should be performed next if chest radiography suggests mediastinal hematoma. CT should be performed before aortography if chest radiography demonstrates no mediastinal hematoma but is not convincingly normal and the patient needs CT studies for associated head and/or abdomen injuries. In this case, if CT is technically correct and its results are normal, aortography needs not be performed, whereas if CT findings are abnormal or not convincingly normal, aortography is mandatory. In the future, the approach to aortic trauma could be modified by transesophageal echocardiography, Magnetic Resonance Imaging and spiral CT, but the results of these imaging methods must still be validated with further extensive studies.