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Prospective study of blunt aortic injury: helical CT is diagnostic and antihypertensive therapy reduces rupture

T C Fabian1, K A Davis, M L Gavant

  • 1Department of Surgery, University of Tennessee, Memphis 38163, USA.

Annals of Surgery
|May 30, 1998
PubMed

Insights

Helical computed tomography of the thorax (HCTT) accurately diagnoses blunt aortic injury (BAI), replacing aortography. Early HCTT diagnosis and antihypertensive treatment prevent aortic rupture.

Area of Science:

  • Trauma surgery
  • Diagnostic imaging
  • Cardiovascular surgery

Background:

  • Aortography is the traditional standard for diagnosing blunt aortic injury (BAI).
  • Conventional CT has limited diagnostic value for BAI.
  • Helical CT scanning offers improved speed and resolution over conventional CT.

Purpose of the Study:

  • To evaluate helical computed tomography of the thorax (HCTT) for diagnosing blunt aortic injury (BAI).
  • To assess the efficacy of beta-blockers, with or without nitroprusside, in preventing aortic rupture.

Main Methods:

  • Prospective study comparing HCTT with aortography for BAI diagnosis.
  • Evaluation of an antihypertensive protocol (beta-blockers +/- nitroprusside) for preventing aortic rupture.

Main Results:

  • HCTT demonstrated 100% sensitivity and 83% specificity for BAI.
  • Aortography showed 92% sensitivity and 99% specificity.
  • No in-hospital aortic ruptures occurred with early HCTT diagnosis and treatment.

Conclusions:

  • HCTT is highly sensitive for diagnosing intimal injuries and pseudoaneurysms.
  • Negative HCTT scans obviate the need for further evaluation.
  • Aortography is reserved for indeterminate HCTT findings; early diagnosis and treatment prevent rupture.
Abstract

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