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Angiography in blunt thoracic aortic injury
K Ahrar1, D C Smith, R C Bansal
1Department of Radiology, Loma Linda University Medical Center, California 92354, USA.
The Journal of Trauma
|April 1, 1997
Summary
Transesophageal echocardiography (TEE) may miss injuries to the thoracic aorta and its branches in blunt chest trauma patients. Aortography is crucial for a complete assessment, as 20% of patients had injuries not adequately seen by TEE.
Area of Science:
- Cardiovascular Surgery
- Trauma Surgery
- Diagnostic Imaging
Background:
- Transesophageal echocardiography (TEE) is increasingly considered for diagnosing traumatic thoracic aortic rupture.
- Limitations exist in TEE's ability to fully visualize the aorta and its arch branches.
Purpose of the Study:
- To evaluate the impact of TEE limitations on diagnosing traumatic aortic and great vessel injuries.
- To assess aortographic features of these injuries in patients with blunt chest trauma.
Main Methods:
- Retrospective review of clinical and imaging data from 89 patients.
- Patients had blunt chest trauma and angiographic evidence of thoracic aorta or great vessel injury.
Main Results:
- 72 patients (81%) had isolated aortic rupture; 1% occurred in the distal ascending aorta, a TEE blind spot.
- 17 patients (19%) had 24 injuries to aortic arch branches; 70% were not suspected clinically.
- In 14 of these 17 patients, the aorta was intact.
Conclusions:
- Twenty percent of patients had injuries to aortic arch branches or distal ascending aorta.
- TEE as the sole imaging modality may lead to suboptimal assessment or missed injuries.
- Aortography remains essential for comprehensive evaluation of blunt chest trauma involving the thoracic aorta.