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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.
Insights
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.
Purpose:
Recent studies have suggested that transesophageal echocardiography (TEE) can be used as the primary imaging method in patients suspected of traumatic rupture of the thoracic aorta. A segment of the aorta and the aortic arch branches cannot be adequately evaluated in all patients by TEE. To assess the impact of these limitations of TEE, this retrospective study examined the aortographic features of traumatic aortic or great vessel injuries in a large number of patients.
Materials And Methods:
We retrospectively reviewed clinical and imaging features of 89 patients with a history of blunt chest trauma and angiographic evidence of traumatic injury to the thoracic aorta or to its branches.
Results:
Of these 89 patients, 72 had aortic rupture alone. One (1%) of these ruptures occurred at the distal ascending aorta, a potential blind spot for TEE. Seventeen patients (19%) had 24 injuries to the aortic arch branches: in 14 of these 17 patients, the aorta was intact, whereas three patients also had aortic rupture. Seventy percent of the injuries to the aortic arch branches were not suspected on physical examination.
Conclusion:
Twenty percent of patients in our retrospective series had traumatic involvement of aortic arch branches or the distal ascending aorta. These vascular injuries may be suboptimally assessed or overlooked if TEE is used as the sole imaging modality in the evaluation of patients with blunt chest trauma.