Diagnosis Of Traumatic Aortic Injury Research Articles

Posttraumatic Resuscitation Affects Stent Graft Sizing in Patients with Blunt Thoracic Aortic Injury

Patients with blunt aortic injury often present to the emergency department in a relatively hypovolemic state. These patients undergo extensive inhospital resuscitation. The effect of posttraumatic resuscitation on aortic diameter has implications for stent graft sizing. The potential utility of repeat aortic imaging after resuscitation remains unclear. A retrospective chart review of all adult patients presenting to a Level I trauma center between the years 2007 and 2013 was performed. Fifty-three patients were identified with a diagnosis of traumatic aortic injury. Of those, 10 had 2 CT scans before aortic repair and were selected as the study population for analysis. After resuscitation, there was a significant increase in aortic diameter both proximal and distal to the aortic injury: proximal aortic diameter increase of 1.97 mm and distal aortic diameter increase of 1.48 mm. This retrospective study shows that after resuscitation, there is a significant increase in proximal and distal aortic diameter. Interval reimaging of the thoracic aorta may be beneficial after adequate stabilization of the patient's other injuries. In certain cases, more appropriate sizing may prevent a device-related complication.

Mathematical Modeling Improves Computed Tomography Diagnosis of Traumatic Aortic Injury

Acute traumatic aorta injuries (ATAIs) following blunt thoracic trauma require rapid and accurate diagnosis for institution of lifesaving treatment. The use of computed tomography (CT) in the diagnosis of such injuries continues to improve and has the potential to become the diagnostic modality of choice in many trauma centers. A standardized diagnostic model may contribute to improvements in radiologist interpretation of CT for ATAIs. The following diagnostic criteria were used to develop a diagnostic model for ATAIs: 11 areas of potential hematoma formation were identified in the mediastinum. Maximum short- and long-axis cross-sectional diameters of the aorta were measured. Qualitative morphologic information (contour change, intimal flap) was recorded. Smoothness of the aorta wall was assessed. These characteristics were quantified and analyzed for statistical significance, allowing for the development of an injury assessment model. The diagnostic model was used to score 69 blunt thoracic trauma patient cases. Average weighted kappa was 0.74, showing strong agreement among two observers and reproducibility of the model. The model improved injury assessment by classifying equivocal cases as either positive or negative. The ROC curve calculated from the original radiologist interpretation contained 86.1% area under the curve, while the curve for the new model contained 97.5%. The likelihood ratio increased from 30.06 to 48.67. The degree to which the new measure improved prediction over the original radiologist reading was tested using a nested model and yielded a reliable increment in model fit (chi2 analysis: Deltachi2(3) = 20.929, P < or = .0001). Finally, beta weights calculated from each variable were used to create a quantitative best-fit diagnostic model for future use. We have developed a diagnostic tool that may help radiologists better evaluate CT for ATAIs.

Imaging blunt traumatic aortic injury: a Canadian tertiary care trauma centre case series

Few individuals survive blunt traumatic aortic injury (TAI); however, the mortality rate is dramatically lowered by timely diagnosis and treatment. We performed a retrospective review of patients that had undergone aortography or were entered in a trauma database with a diagnosis of TAI between December 1, 1996, and April 1, 2004. The diagnostic utility of computed tomography (CT) was compared to the gold standards of aortography and operative findings. Forty charts were reviewed. Fifty-two percent had indirect CT signs and 39 percent had direct CT signs of TAI. Six TAI’s were surgically confirmed and repaired. Computed tomography for TAI had a sensitivity of 100 percent and a specificity of 74 percent. Computed tomography imaging has obviated aortography in screening for TAI. Aortography continues to have a valuable diagnostic role prior to surgical management.

Mid-term Results of Conservative, Conventional and Endovascular Treatment for Acute Traumatic Aortic Lesions

Background To analyze our results after conservative, conventional and endovascular treatment for acute traumatic aortic lesions during the last decade. Methods From June 1993 to September 2004, a total of 19 patients with traumatic aortic lesions were referred to our department. All patients sustained injuries from blunt deceleration trauma. In hemodynamically stable patients, initial evaluation was by multi-slice CT scan. The diagnosis of traumatic aortic injury was confirmed and an individual treatment strategy was determined. In hemodynamically unstable patients, emergency thoracotomy was performed. Results An emergency thoracotomy was performed in seven (37%) patients. Mortality in this group was 100%. In the remaining group of 12 (63%) patients without hemodynamic instability at time of admission, in-hospital mortality was 0%. Treatment was surgical in five patients (26%), endovascular in five (26%) and conservative in two patients (11%). Mean follow-up was 63 months (5–108 months). No patient died during follow-up. In patients treated by endovascular stent-graft placement no signs of endoleaks could be detected. Conclusions Hemodynamic stability and an individual treatment strategy are prerequisites for survival of acute traumatic aortic lesions. Endovascular stent-graft placement has emerged as an innovative and minimally invasive therapeutic option in this polytraumatic high-risk patient cohort.

Transesophageal Echocardiography for Diagnosis of Traumatic Aortic Injury: An Appraisal of the Evidence

An overview of the validity of transesophageal echocardiography (TEE) in patients suspected to have traumatic aortic injury (TAI). Computerized bibliographic search of trials from 1994 to 2002 evaluating the use of TEE to confirm the diagnosis of TAI. Seven relevant studies out of 204 were identified, involving 758 patients. The accuracy of TEE was analyzed by constructing summary receiver-operating characteristic (sROC) curves and computing areas under the sROC curve. No prospective randomized trial was found. Although accuracy varied greatly, summary ROC curve found that TEE enjoyed a high diagnostic performance. Some study characteristics can affect accuracy. Our findings seems to indicate that TEE is a valuable tool for diagnosing TAI, and its use as first-line evaluation of such patients can be supported; however, given the lack of randomized trials, no standard of care can be drawn from the present overview: future studies should look at this problem more carefully, and should be methodologically rigorous.

Utilisation de l’échocardiographie Doppler dans la prise en charge des lésions cardiovasculaires traumatiques

Over the last decade, the initial assessment of patients presenting with a severe thoracic trauma changed dramatically. Angiography, historically considered the reference imaging modality for the diagnosis of traumatic aortic injuries (TAI), has been supplanted by non invasive techniques. Multiplane transesophageal echocardiography (TEE) or contrast-enhanced helical computed tomography of the chest are first-line imaging techniques currently used in most trauma centers for the screening of patients with suspected TAI. With the respect of a learning curve, TEE is an accurate imaging modality for the diagnosis of TAI and blunt cardiac trauma. In addition to its diagnostic capability, TEE provides valuable information which help guiding the therapeutic management of injured patients. The acute management of patients presenting with a precordial wound is mainly based on the early diagnosis of hemopericardium which should prompt surgical repair of an underlying cardiac injury. Accordingly, transthoracic echocardiography is the pivotal test performed upon admission, whereas TEE is usually performed peroperatively to precisely identify associated cardiac injuries. In summary, echocardiography Doppler is a pivotal imaging modality for the assessment of patients at high risk of sustaining blunt or penetrating cardiovascular trauma. This implies a consistent availability of full-featured echocardiographic systems and trained operators in trauma centers.

Imaging of acute traumatic injuries of the thoracic aorta

Blunt traumatic aortic injuries are a major concern in the settings of high-speed deceleration accidents, since they are associated with a very high mortality rate; however, with prompt diagnosis and surgery, 70% of the patients with a blunt aortic lesion who reach the hospital alive will survive. This statement challenges the emergency radiologist in charge to evaluate the admission radiological survey in a severe chest trauma patient. With a 95% negative predictive value for the identification of blunt traumatic aortic lesions, plain chest film represents an adequate screening test. If aortography remains the gold standard, it tends, at least in hemodynamically stable trauma patients, to be replaced by spiral-CT angiography (SCTA), which demonstrates a 96.2% sensitivity, a 99.8% specificity, and a 99.7% accuracy. In unstable patients, trans-esophageal echography (TEE) plays a major diagnostic role. Knowledge of advantages and pitfalls of these imaging techniques, as reviewed in this article, will help the emergency radiologist to choose the appropriate algorithm in the diagnosis of traumatic aortic injury, for each trauma patient.

9 Transoesophageal echocardiography in trauma patients

Transoesophageal echocardiography (TOE) is an outstanding tool for the clinical management of trauma patients. It provides valuable information on haemodynamic instability, diagnosis of myocardial contusion, traumatic valve dysfunction, traumatic aortic injuries, intrathoracic bleeding and systemic gas embolism related to pulmonary contusion. The accuracy of TOE in the diagnosis of traumatic aortic injuries is not perfectly determined: the main limitation is the operator dependency. Experience of trauma patients and specific signs of cardiovascular injuries are the keys to the extensive use of TOE in trauma centres. The main interest in TOE is the capability to perform TOE promptly upon admission, in the intensive care unit and in the operative room. In the case of delayed surgery of aortic injuries, TOE examination can participate in the decision-making process.

Spiral CT aortography: an efficient technique for the diagnosis of traumatic aortic injury.

The objective of this study was to assess the efficiency of spiral CT (SCT) aortography for diagnosing acute aortic lesions in blunt thoracic trauma patients. Between October 1992 and June 1997, 487 SCT scans of the chest were performed on blunt thoracic trauma patients. To assess aortic injury, the following SCT criteria were considered: hemomediastinum, peri-aortic hematoma, irregular aspect of the aortic wall, aortic pseudodiverticulum, intimal flap and traumatic dissection. Aortic injury was diagnosed on 14 SCT examinations (2.9 %), five of the patients having had an additional digital aortography that confirmed the aortic trauma. Twelve subjects underwent surgical repair of the thoracic aorta, which in all but one case confirmed the aortic injury. Two patients died before surgery from severe brain lesions. The aortic blunt lesions were confirmed at autopsy. According to the follow-up of the other 473 patients, we are aware of no false-negative SCT examination. Our limited series shows a sensitivity of 100 % and specificity of 99.8 % of SCT aortography in the diagnosis of aortic injury. It is concluded that SCT aortagraphy is an accurate diagnostic method for the assessment of aortic injury in blunt thoracic trauma patients.

Traumatic aortic injuries in children: radiologic evaluation.

The purpose of this study was to evaluate the radiographic findings in children with traumatic aortic injuries and discuss the imaging techniques currently available for diagnosis. A retrospective review of 10,886 children examined because of blunt trauma from 1987 to April 1996 identified seven patients (0.064%) who sustained traumatic aortic injuries. The mechanism of injury, location of aortic injury, additional injuries suffered, trauma scores, sequences of radiologic evaluation, imaging findings, treatment, and outcome were recorded for each child. Six children had pathologically proven aortic ruptures, and the remaining child had an intimal injury diagnosed with contrast-enhanced helical CT and confirmed with transesophageal echocardiography. All seven children were victims of motor vehicle accidents (six passengers, one pedestrian), all had injuries of the aortic isthmus, and all had additional severe injuries. The mean trauma score, injury severity score, and probability of survival were 14, 39, and 75%, respectively. Imaging techniques included chest radiography (n = 7), conventional CT (n = 1), helical CT (n = 3), aortography (n = 2), and transesophageal echocardiography (n = 3). The initial outcomes included death (n = 1), paraplegia (n = 1), paraparesis (n = 2), and recovery without morbidity (n = 3). Traumatic aortic injuries are rare in children. The most common findings on plain films are a left apical cap, pulmonary contusion, aortic obscuration, and mediastinal widening. Helical CT and transesophageal echocardiography can be used in the diagnosis of traumatic aortic injuries in children.

Use of Transesophageal Echocardiography for Diagnosis of Traumatic Aortic Injury

This prospective study was conducted to describe the signs on transesophageal echocardiography (TEE) associated with traumatic aortic injury (TAI). Twenty-eight patients with TAI underwent TEE, and they were compared with a control group of 30 thoracic trauma patients without aortic injury. The TEE signs were classified as direct or indirect signs, and the quality of imaging was assessed. Patients' TEE images were compared with their anatomic lesions. The direct signs were thick stripes (n=19), false aneurysm (n=7), aortic dissection (n=6), free-edge intimal flap (n=15), aortic wall hematoma (n=2), fusiform aneurysm (n=13), and complete aortic obstruction (n=2). The indirect signs included minor increases in aortic diameter (n=7), impairment of the aortic Doppler color flow (n= 18), and an increase of aorta-probe distance, indicating hemomediastinum (n=23). TEE allowed diagnosis of recently described limited intimal lesions frequently missed by other conventional methods, and permitted rapid diagnosis of complete rupture in which fast degeneration means that more time-consuming methods are not practicable. Significant blurring of the aortic outline was noted in 20% of cases and intraluminal artifacts were observed in 36% of cases, but neither sign impaired accurate diagnosis of TAI. The echocardiographic signs of aortic injury are complex and may be confined to a short section of the aorta. Therefore, examination by a physician highly trained in echocardiography is necessary in such cases.