Acute traumatic injuries of thoracic aorta: Role of 64-MDCTA in diagnosis and management

Abstract

ObjectivesReview our experience with 64-MDCTA in diagnosis and management of patients with acute traumatic injury of thoracic aorta. Patients and methodsThirty-five patients with possible traumatic aortic injury were subjected to 64-MDCTA. Arterial and delayed phases were acquired for chest, abdomen and pelvis. Positive findings were encountered in 24 patients, surgical repair done for 7 cases, endovascular repair for 14 cases and follow up for 1 case. Two patients died before intervention. The remaining 11 patients had no direct signs of ATAI and their follow up was uneventful. All cases planned for EVR were subjected to conventional aortography as part of the treatment process. MDCTA findings were compared with surgical, aortography findings and clinic-radiologic follow up. ResultsDirect positive MDCTA findings in 24 cases included pseudoaneurysm (23), transection (15), intimal tear (12), intimal flap (10), intramural–intraluminal hematoma (1) and active bleeding (3). Mediastinal hematoma as an indirect sign was detected in all cases. MDCTA findings correlated well with surgical and aortography findings. ConclusionStable patients with potential ATAI should be subjected first to urgent MDCTA. This will offer rapid reliable diagnosis, plan intervention and avoid invasive aortography that will be indicated only if endovascular repair is decided.