Can Chest CT Be Used to Exclude Aortic Injury?1
Debra S. Dyer, MD,
Ernest E. Moore, MD,
Michael F. Mestek, MD,
Steven M. Bernstein, MD,
Dave N. Iklé, PhD,
Janette D. Durham, MD,
Marsha J. Heinig, MD,
Paul D. Russ, MD,
David L. Symonds, MD,
David A. Kumpe, MD,
Edward J. Roe, MD,
Benjamin Honigman, MD,
Robert C. McIntyre, Jr, MD and
John Eule, Jr, MD
1 From the Depts of Radiology (D.S.D., S.M.B., J.D.D., P.D.R., D.A.K.) and Surgery (R.C.M.), Div of Emergency Medicine (B.H.), University of Colorado Health Sciences Center, Box A030, 4200 E 9th Ave, Denver, CO 80262; Depts of Surgery (E.E.M.) and Radiology (M.F.M., M.J.H., D.L.S., J.E.), Div of Emergency Medicine (E.J.R.), Denver Health Medical Center, Colo; and Dept of Biostatistics, National Jewish Medical and Research Center, Denver (D.N.I.). Received Jul 20, 1998; revision requested Aug 28; revision received Dec 14; accepted Mar 26, 1999. Supported in part by a grant from the Society for Thoracic Radiology Research and Education Fund. Address reprint requests to D.S.D. (e-mail: Deb.Dyer@UCHSC.edu).
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Figure 1a. (a) Helical CT scan obtained in a 56-year-old man who was in a motorcycle accident shows a direct sign of traumatic aortic injury. An intraluminal irregularity (ie, intimal flap) (arrow) is seen. (b) Aortogram obtained in the same patient confirms the presence of a pseudoaneurysm at the aortic isthmus.
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Figure 1b. (a) Helical CT scan obtained in a 56-year-old man who was in a motorcycle accident shows a direct sign of traumatic aortic injury. An intraluminal irregularity (ie, intimal flap) (arrow) is seen. (b) Aortogram obtained in the same patient confirms the presence of a pseudoaneurysm at the aortic isthmus.
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Figure 2a. (a, b) CT scans obtained in a 21-year-old man who was in a motor vehicle accident show periaortic hematoma and direct CT signs of traumatic aortic injury. (a) Axial CT scan demonstrates a very unusual contour of the aorta, which appears to have two lumens; however, one of the lumens (arrows) is actually extravasated blood. (b) The more caudal scan shows circumferential periaortic hematoma (arrows). Findings on the thoracic aortogram (not shown) obtained in this patient confirmed the presence of a pseudoaneurysm in the descending aorta.
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Figure 2b. (a, b) CT scans obtained in a 21-year-old man who was in a motor vehicle accident show periaortic hematoma and direct CT signs of traumatic aortic injury. (a) Axial CT scan demonstrates a very unusual contour of the aorta, which appears to have two lumens; however, one of the lumens (arrows) is actually extravasated blood. (b) The more caudal scan shows circumferential periaortic hematoma (arrows). Findings on the thoracic aortogram (not shown) obtained in this patient confirmed the presence of a pseudoaneurysm in the descending aorta.
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Figure 3a. (a, b) Axial CT scans obtained in a 45-year-old man who was in a motor vehicle accident show direct CT signs of aortic injury: (a) an intraluminal irregularity (arrow) and (b) a markedly abnormal aortic contour (arrows). Aortic injury was confirmed at surgery.
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Figure 3b. (a, b) Axial CT scans obtained in a 45-year-old man who was in a motor vehicle accident show direct CT signs of aortic injury: (a) an intraluminal irregularity (arrow) and (b) a markedly abnormal aortic contour (arrows). Aortic injury was confirmed at surgery.
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Figure 4. Axial CT scan obtained in a 25-year-old woman shows mediastinal hemorrhage (arrows) limited to the anterior mediastinum; there was no periaortic hemorrhage. The follow-up aortogram (not shown) obtained in this patient was normal.
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Figure 5a. Traumatic aortic injury in a 23-year-old man, with no obvious direct CT findings. (a, b) Helical CT scans demonstrate periaortic hematoma (arrows in a) and a very subtle caliber change in the descending aorta but no intraluminal irregularity or abnormal aortic contour. Interestingly, a large hemopericardium (arrowheads in b) is noted. (c) Thoracic aortogram obtained in the same patient shows a very small posterior pseudoaneurysm (arrows) at the level of the arch.
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Figure 5b. Traumatic aortic injury in a 23-year-old man, with no obvious direct CT findings. (a, b) Helical CT scans demonstrate periaortic hematoma (arrows in a) and a very subtle caliber change in the descending aorta but no intraluminal irregularity or abnormal aortic contour. Interestingly, a large hemopericardium (arrowheads in b) is noted. (c) Thoracic aortogram obtained in the same patient shows a very small posterior pseudoaneurysm (arrows) at the level of the arch.
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Figure 5c. Traumatic aortic injury in a 23-year-old man, with no obvious direct CT findings. (a, b) Helical CT scans demonstrate periaortic hematoma (arrows in a) and a very subtle caliber change in the descending aorta but no intraluminal irregularity or abnormal aortic contour. Interestingly, a large hemopericardium (arrowheads in b) is noted. (c) Thoracic aortogram obtained in the same patient shows a very small posterior pseudoaneurysm (arrows) at the level of the arch.
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Figure 6a. (a, b) False-positive axial CT scans obtained in a 62-year-old man after a 40-foot fall show periaortic hematoma due to a thoracic spine fracture. (a) Scan of the lower region of the thorax shows hematoma surrounding the descending thoracic aorta. (b) The more caudal scan of the upper abdomen shows a burst fracture of the T12 vertebra. The thoracic aortogram (not shown) obtained in this patient was normal.
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Figure 6b. (a, b) False-positive axial CT scans obtained in a 62-year-old man after a 40-foot fall show periaortic hematoma due to a thoracic spine fracture. (a) Scan of the lower region of the thorax shows hematoma surrounding the descending thoracic aorta. (b) The more caudal scan of the upper abdomen shows a burst fracture of the T12 vertebra. The thoracic aortogram (not shown) obtained in this patient was normal.
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Figure 7. Axial CT scan obtained in a 42-year-old man who was in a motor vehicle accident shows left lower lobe subsegmental atelectasis (arrows) simulating periaortic hematoma. However, the fat planes around the aorta are distinct; this makes hematoma unlikely. The follow-up aortogram (not shown) obtained in this patient was normal.
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Figure 8. Diagram illustrates a recommended CT scanning algorithm. OR = operating room, TAI = traumatic aortic injury.
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Copyright © 1999 by the Radiological Society of North America.
