Learning objectives
Our goal is to give a brief overview of blunt aortic trauma (BAT) – its mechanism,
radiologic findings and pitfalls by
reviewing shortly the normal anatomy of the thoracic aorta
giving a quick overview of blunt aortic trauma mechanism
listing radiological findings in plain chest films and MDCT.
showing typical and atypical findings in blunt aortic trauma and reveal most common pitfalls
Background
Blunt aortic injury is a severe and life-threatening concern which is most commonly associated with deceleration or crush injury.
It is the second most common cause of death in blunt trauma patients,
most often inhigh velocity MVC (motor vehicle collisions).
Only about 10-20% of the patients reach the emergency departement livelily whereas hemodynamically unstable patients have a 2% chance of survival.
So fast an accurate diagnosis is vital.
Anatomy:
The thoracic aorta is divided into 4 parts (max.
diameter in cm)
-aortic root (4 cm)...
Imaging findings OR Procedure details
Depending on the patient’s condition either a chest x-ray or a CT will be performed.
Chest x-ray is taken in upright p.a.
and left lateral position or in supine position if not otherwise possible.
The radiograph is evaluated specifically for signs of mediastinal hematoma such as:
widening of the mediastinal shadow
altered configuration of theaorta
deviation of the trachea or a nasogastric tube to the right of the spinous process of T4.
loss of the aorticopulmonary window.
presence of pleural effusion,
typically on the left....
Conclusion
Blunt aortic trauma (BAT) is a life-threatening condition and requires rapid diagnosis and treatment.
Multidetector CT can quickly and accurately display aortic trauma with a high sensitivity and specificity.
Chest x-ray can be considered for screening but in the emergency setting MDCT is the modality of choice.
Profound knowledge of direct and indirect CT imaging findings,
pearls and pitfalls enables diagnosis and image-based triage of patients to open surgery,
endovascular or conservative treatment.
References
Hatem Alkadhi,
Simon Wildermuth,
Lotus Desbiolles et al.
Vascular emergencies of the Thorax after Blunt and Iatrogenic Trauma: Multi-Detector Row CT and Three-dimensional Imaging.
Radiographics 2004; 24:1239-1255.
John D.
Creasy,
Caroline Chiles,
William D.
Routh,
Raymond B.
Dyer.
Overview of Traumatic Injury of the Thoracic Aorta.
Radiographics 1997; 17: 27-45.
Richard G.
Fisher,
Modesto Sanchez-Torres,
John W.
Thomas,
Cliff J.
Whigham.
Subtle or Atypical Injuries of the Thoracic Aorta and Brachiocephalic Vessels in Blunt Thoracic Trauma.
Radiographics 1997; 17: 835-849.
Ferco H.
Berger,
Krijn P....