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Acute Traumatic Thoracic Aortic Injuries: Experience with 64-MDCT

¹ Both authors: Department of Radiology, Medical University of South Carolina, PO Box 250322, 169 Ashley Ave., Charleston, SC 29425.

View larger version (138K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —31-year-old man with injury to aortic isthmus. Contrast-enhanced sagittal reformatted CT image shows segmental transection with contour abnormality and periaortic hematoma (arrow). Isthmus was most common location of acute traumatic aortic injury in series.

View larger version (157K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —53-year-old man with combined acute traumatic injuries to aortic root and isthmus (Reprinted with permission from Steenburg S, Ravenel J, Ikonomidis J. Blunt traumatic injury of the ascending aorta: multidetector CT findings in two cases. Emerg Radiol 2007; 13:217–221 [19]). Axial contrast-enhanced MDCT image at level of aortic isthmus shows irregular contour of anterior descending aorta (arrows) with surrounding periaortic hematoma (arrowheads) due to transection extending along ascending aorta and main pulmonary artery. Bilateral pleural effusions and atelectasis also are present.

View larger version (172K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —53-year-old man with combined acute traumatic injuries to aortic root and isthmus (Reprinted with permission from Steenburg S, Ravenel J, Ikonomidis J. Blunt traumatic injury of the ascending aorta: multidetector CT findings in two cases. Emerg Radiol 2007; 13:217–221 [19]). Axial contrast-enhanced MDCT image at level of aortic root shows abnormal collection of contrast material immediately anterior and inferior to aortic root (arrow). No associated hemopericardium is present at this level.

View larger version (146K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —53-year-old man with combined acute traumatic injuries to aortic root and isthmus (Reprinted with permission from Steenburg S, Ravenel J, Ikonomidis J. Blunt traumatic injury of the ascending aorta: multidetector CT findings in two cases. Emerg Radiol 2007; 13:217–221 [19]). Coronal multiplanar reformation shows abnormal focal collection of contrast material at aortic root (arrow). Periaortic hematoma is remote from site of injury (arrowheads) to ascending aorta. Irregularity involving main pulmonary artery (asterisk) is due to cardiac motion artifact, not injury.)

View larger version (155K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —47-year-old woman with injury to intima of mid descending thoracic aorta. Transverse contrast-enhanced CT image shows intimal flap (arrow) within aortic lumen and minimal periaortic hematoma.

View larger version (132K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —47-year-old woman with injury to intima of mid descending thoracic aorta. Catheter angiogram shows small intimal tear (arrow). Patient was treated conservatively.

View larger version (119K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —27-year-old woman with traumatic intramural hematoma. Contrast-enhanced CT image shows circumferential intramural hematoma (arrow) along most of descending thoracic aorta.

View larger version (193K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —27-year-old woman with traumatic intramural hematoma. Catheter angiogram in left anterior oblique projection does not show injury.

View larger version (134K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —27-year-old woman with traumatic intramural hematoma. Contrast-enhanced CT image obtained on hospital day 10 because of distal embolic signs shows small mural thrombus (arrow), presumably due to small intimal tear.

View larger version (180K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5 —26-year-old man with minimal aortic injury at aortic hiatus. Contrast-enhanced CT image shows small mural thrombus (arrow) on left side of aorta. Patient was treated conservatively and discharged on hospital day 7.

View larger version (124K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —32-year-old man with periaortic hematoma without aortic injury. Contrast-enhanced CT image shows thoracic vertebral body burst fracture (arrowhead) with adjacent hematoma (H) but no direct signs of aortic injury. Atelectasis (arrow) adjacent to aorta mimics intimal flap.

View larger version (177K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —32-year-old man with periaortic hematoma without aortic injury. Catheter angiogram in left anterior oblique projection shows no evidence of aortic injury. Asterisk indicates aortic isthmus.

View larger version (152K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7A —49-year-old woman with 64-MDCT findings that were equivocal owing to ductus diverticulum and periaortic hematoma. Sagittal contrast-enhanced reformatted CT image shows irregular fingerlike projection with ill-defined inferior border and surrounding hematoma (arrow) arising from lesser curvature of transverse aortic arch, interpreted as equivocal but probable ductus diverticulum.

View larger version (183K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7B —49-year-old woman with 64-MDCT findings that were equivocal owing to ductus diverticulum and periaortic hematoma. Right anterior oblique catheter angiogram shows fingerlike projection (arrow) from aortic isthmus.

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