Pearls and pitfalls in imaging of blunt traumatic thoracic aortic injury: a pictorial review.

Abstract

Blunt thoracic aortic injury (TAI) occurs most frequently as a sequelae of high impact deceleration such as high-velocity road traffic accidents and falls from height. The burden of mortality and morbidity is high, however advances in pre-hospital care, diagnostic imaging and endovascular therapies have improved outcomes in this group of patients. Emergent treatment depends on accurate, early diagnosis by the radiologist. It is therefore of paramount importance that radiologists are familiar with both the direct (intimal flap, pseudoaneurysm, aortic contour irregularity and contrast extravasation) and indirect (periaortic haematoma) imaging findings of TAI. Furthermore, it is critical that technical (breathing artefact and cardiac motion artefact) as well as anatomical (ductus diverticulum, aortic spindle and mediastinal structures which imitate periaortic haematoma) pitfalls are recognised to avoid misdiagnosis. This pictorial review will help the diagnostic radiologist to recognise the patterns of injury and imaging features associated with TAI, as well as highlighting potential mimics when interrogating CTangiography (CTA) in major trauma.