Imaging of thoracic aortic injury

Abstract

Isthmic aortic rupture or disruption should be systematically sought when there is high kinetic energy trauma to the thorax. This condition is extremely serious and life threatening. It needs to be diagnosed rapidly but diagnostic pitfalls must be avoided. CT angiography is the standard examination. The main CT signs of rupture or disruption of the thoracic aorta are periaortic hematoma, intimal flap, pseudo-aneurysm and contrast agent extravasation. There are three types of lesion: intimal, subadventitial or pseudo-aneurysmal, and complete rupture with lesion of the three tunicae, and it is important to grade them for better therapeutic management. The main diagnostic pitfalls of the CT scan are the presence of a ductus diverticulum and post-isthmic fusiform dilatation. Associated lesions must not be overlooked. The most common are ruptures of the aortic root and the thoracic aorta in the diaphragmatic hiatus.

Presentación atípica de injuria aórtica por traumatismo cerrado de tórax

“…En un estudio retrospectivo se observó que el traumatismo de tórax está acompañado en el 31% de los casos por injuria craneana y en el 29% por injuria abdominal 5 . El 30% de los pacientes con injuria de aorta no presentan signos externos de traumatismo torácico y el 75% tienen fractura de costillas 4 .La muerte intrahospitalaria en pacientes que no reciben el tratamiento adecuado es del 30% dentro de las primeras 6 horas, el 40-50% dentro de las 24 horas y 90% dentro de los 4 meses 6 . El caso que se presenta tiene una evolución mayor al año hasta la realización del tratamiento adecuado.…”

Traumatic injuries of the thoracic aorta: The role of imaging in diagnosis and treatment

“…8). If there is any doubt, CT angiography with ECG-gating or a transoesophageal echocardiogram will allow this pathology to be excluded in stable patients [8][9][10][11][12][13][14][15].…”

“…This consists of a pre-contrast acquisition of the head and neck, followed by an arterial phase acquisition covering the neck, chest, abdomen and pelvis. This is usually followed by a portal phase acquisition of the abdomen and pelvis, so that any injuries to wholly intra-abdominal organs can be better studied [10].…”

Lésions traumatiques de l’aorte thoracique

“…Il comprend une acquisition sans injection de produit de contraste crâniale et cervicale, suivie d'une acquisition au temps artériel couvrant les étages cervical, thoracique, abdominal et pelvien. Celle-ci est habituellement suivie d'une acquisition au temps portal centrée sur l'étage abdomino-pelvien, afin de mieux étudier les lésions des organes pleins intra-abdominaux [10].…”

“…8). En cas de doute, l'angioscanner couplé à la synchronisation cardiaque ou une échocardiographie trans-oesophagienne permettent d'éliminer cette pathologie chez les patients stables [8][9][10][11][12][13][14][15].…”