Blunt thoracic aortic injuries: CT characterisation and treatment outcomes of minor injury

Computed tomography (CT)-defined anatomical differentiation of minor and major blunt traumatic aortic injuries (TAIs) was applied to determine injury grade and management/outcomes in minor TAIs, and if the presence of peri-aortic mediastinal haematoma (MH) correlated with TAI grade. Admission chest CT of blunt TAI cases during 2005-2011 were reviewed by consensus and categorised as major or minor. Minor was defined as pseudoaneurysm < 10 % normal aortic lumen, intimal flap or contour abnormality. Presence/absence of MH was determined. Clinical management/outcome was ascertained from medical records. Of 115 TAIs, 42 were minor (33 with MH, 9 without). Among the 73 with major TAI, 3 had no MH. Twenty-six (62 %) minor TAI patients were managed medically, 12 (29 %) percutaneous stent-grafts, 2 (5 %) died of non-aortic causes and 2 (5 %) underwent surgery. Of 26 managed without intervention, none developed complications from TAI at last clinical or CT follow-up. The relationship between presence/absence of peri-aortic MH and grade of TAI was statistically significant. More than a third of multi-detector (MD) CT-diagnosed TAIs were minor. Minor TAIs treated medically were stable at last follow-up, suggesting this is a reasonable initial management approach. Absence of MH cannot be relied upon to exclude minor TAI, indicating the need for careful direct aortic inspection. aEuro cent MDCT can differentiate minor from major blunt traumatic aortic injuries. aEuro cent About one-third of MDCT-diagnosed blunt traumatic aortic injuries are minor. aEuro cent Minor aortic injuries are not necessarily accompanied by mediastinal haemorrhage. aEuro cent MDCT diagnosis of minor aortic injury supports application of medical management.