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Traumatic Aortic Rupture: CT Evidence of a Dynamic Process

William C. Torreggiani1, David Liu and John R. Mayo

1 All authors: Department of Radiology, Vancouver General Hospital, 899 W. 12th Ave., Vancouver, B. C., V5Z 1M9 Canada.



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  		Fig. 1A. —31-year-old man who sustained high-speed trauma. Chest radiograph in supine anteroposterior view obtained on portable unit at first admission shows right-sided pneumothorax (arrows), mild widening of mediastinum, indistinctness of aortic arch, and absence of definable aortic—pulmonary window.

 


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  		Fig. 1B. —31-year-old man who sustained high-speed trauma. Nonhelical contrast-enhanced CT scan obtained using 10-mm collimation at level of aortic isthmus 30 min after A shows circumferential enlargement of aortic isthmus region and target appearance of contrast column. These changes are believed to represent concentric dissection of aorta, with low-attenuation ring (arrow) representing intimal flap.

 


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  		Fig. 1C. —31-year-old man who sustained high-speed trauma. Chest radiograph in supine anteroposterior view obtained on portable unit 5 hr after A shows progressive widening of mediastinum. Chest tube has been placed in right hemithorax, draining previously identified right-sided pneumothorax.

 


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  		Fig. 1D. —31-year-old man who sustained high-speed trauma. Helical contrast-enhanced CT scan obtained using 3-mm collimation at level of aortic isthmus 5 hr after B shows focal pseudoaneurysm (arrow) of left anterolateral aortic wall. Interval changes include increase in size of mediastinal hematoma, development of left-sided pleural effusion, and progressive infiltration and atelectasis in both lower lobes.

 


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  		Fig. 1E. —31-year-old man who sustained high-speed trauma. Sagittal reformation of proximal descending aorta created from D shows relationship of focal pseudoaneurysm (large arrows) and intimal flap (small arrow) to origin of left subclavian artery (curved arrow).

 

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