Minimal aortic injury of the thoracic aorta: Imaging appearances and outcome

被引：30

作者：

Gunn M.L.D. ^{[1
]}

Lehnert B.E. ^{[1
]}

Lungren R.S. ^{[2
]}

Narparla C.B. ^{[1
]}

Mitsumori L. ^{[1
]}

Gross J.A. ^{[1
]}

Starnes B. ^{[2
]}

机构：

[1] Department of Radiology, Harborview Medical Center, University of Washington, Seattle, WA 98104, Box 359728

[2] Department of Surgery, Harborview Medical Center, University of Washington, Seattle, WA

来源：

Emergency Radiology | 2014年 / 21卷 / 3期

关键词：

Blunt thoracic aortic injury; Blunt thoracic trauma; CT angiography; MDCT; Minimal aortic injury;

D O I：

10.1007/s10140-013-1187-8

中图分类号：

学科分类号：

摘要：

The aim of this study is to describe the frequency, computed tomographic angiography (CTA) imaging appearance, management, and outcome of patients who present with minimal thoracic aortic injury. This retrospective study was Institutional Review Board-approved. Eighty-one patients with blunt traumatic aortic injuries (BTAI) were identified between 2004 and 2008, comprising 23 patients with minimal aortic injury (MAI) (mean age, 43.2 years ±18.2 years; 12 males and 11 females) and 58 patients with non-minimal aortic injury (mean age, 42.6 years ±22.7 years). CTA imaging was reviewed for each patient to differentiate those with MAI from those with non-MAI BTAI. Inclusion criteria for MAI on CTA were: post-traumatic abnormality of the internal contour of the aorta wall projecting into the lumen, intimal flap, intraluminal filling defect, intramural hematoma, and no evidence of an abnormality to the external contour of the aorta. Relevant follow-up imaging for MAI patients was also reviewed for resolution, stability, or progression of the vascular injury. The electronic medical record of each patient was reviewed and mechanism of injury, injury severity score, associated injuries, type and date of management, outcome, and days from injury to last medical consultation. Minimal aortic injury represented 28.4 % of all BTAI over the study period. Mean injury severity score (37.1), age (43.2 years), and gender did not differ significantly between MAI and non-MAI types of BTAI. Most MAI occurred in the descending thoracic aorta (16/23, 69 %). Without operative or endovascular repair, there was no death or complication due to MAI. One death occurred secondary to MAI (4.4 %) in a patient who underwent endovascular repair and surgical bypass, compared with an overall mortality rate of 8.6 % in the non-MAI BTAI group (p=0.508). The most common CT appearance of MAI was a rounded or triangular intra-luminal aortic filling detect (18/23 patients, 78 %). In a mean of 466 days of clinical follow-up, no complications were observed in survivors treated without endovascular repair or operation. Minimal aortic injury is identified by multi-detector row CT in more than a quarter of cases of BTAI and has a low mortality. Conservative management is associated with an excellent outcome. © 2014 Am Soc Emergency Radiol.

引用

页码：227 / 233

页数：6

共 26 条

[1]

Heiberg E., Wolverson M.K., Sundaram M., Shields J.B., CT in aortic trauma, American Journal of Roentgenology, 140, 6, pp. 1119-1124, (1983)

[2]

Steenburg S.D., Ravenel J.G., Acute traumatic thoracic aortic injuries: Experience with 64-MDCT, AJR Am J Roentgenol, 191, pp. 1564-1569, (2008)

[3]

Mirvis S.E., Thoracic vascular injury, Radiol Clin North Am, 44, (2006)

[4]

Bruckner B.A., DiBardino D.J., Cumbie T.C., Et al., Critical evaluation of chest computed tomography scans for blunt descending thoracic aortic injury, Ann Thorac Surg, 81, pp. 1339-1346, (2006)

[5]

O'Connor J.V., Byrne C., Scalea T.M., Griffith B.P., Neschis D.G., Vascular injuries after blunt chest trauma: Diagnosis and management, Scand J Trauma Resusc Emerg Med, 17, (2009)

[6]

Dyer D.S., Moore E.E., Mestek M.F., Bernstein S.M., Ikle D.N., Durham J.D., Heinig M.J., Russ P.D., Symonds D.L., Kumpe D.A., Roe E.J., Honigman B., McIntyre Jr. R.C., Eule Jr. J., Can chest CT be used to exclude aortic injury?, Radiology, 213, 1, pp. 195-202, (1999)

[7]

Melton S.M., Kerby J.D., McGiffin D., McGwin G., Smith J.K., Oser R.F., Cross J.M., Windham S.T., Moran S.G., Hsia J., Rue III L.W., The Evolution of Chest Computed Tomography for the Definitive Diagnosis of Blunt Aortic Injury: A Single-Center Experience, Journal of Trauma - Injury, Infection and Critical Care, 56, 2, pp. 243-250, (2004)

[8]

Fabian T.C., Davis K.A., Gavant M.L., Et al., Prospective study of blunt aortic injury: Helical CT is diagnostic and antihypertensive therapy reduces rupture, Ann Surg, 227, pp. 666-676, (1998)

[9]

Steenburg S.D., Ravenel J.G., Ikonomidis J.S., Schonholz C., Reeves S., Acute traumatic aortic injury: Imaging evaluation and management, Radiology, 248, pp. 748-762, (2008)

[10]

Malhotra A.K., Fabian T.C., Croce M.A., Weiman D.S., Gavant M.L., Pate J.W., Minimal aortic injury: A lesion associated with advancing diagnostic techniques, Journal of Trauma - Injury, Infection and Critical Care, 51, 6, pp. 1042-1048, (2001)

← 1 2 3 →