Minimal Aortic Injury Detected on Computed Tomography Angiography during Initial Trauma Imaging: Single Academic Level 1 Trauma Center Experience

Gharai, Leila Rezai; Ovanez, Christopher; Goodman, William C.; Deng, Xiaoyan; Bandyopadhyay, Dipankar; Aboutanos, Michel B.; Parker, Mark S.

doi:10.1055/s-0042-1757793

Cited by 3 publications

(2 citation statements)

References 32 publications

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“…The determination of the severity of the injury would help plan the therapeutic steps. The differentiation of minimal aortic injury (MAI) and significant aortic injury (SAI) is mainly performed based on the absence or presence of external aortic wall deformity according to the Society of Vascular Surgery classification [ 17 ]. There are four types of MAI and SAI, ranging from an initial tear or flap (Type I) to an open rupture (Type IV).…”

Section: Discussionmentioning

confidence: 99%

Successful management of a delayed presentation of traumatic descending thoracic aorta pseudoaneurysm: a literature review based on a case report

Sadeghian,

Ebrahimi,

Soltani

et al. 2024

Int J Emerg Med

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Background Blunt traumatic aortic injury (BTAI) is the second leading cause of death due to traumas in young patients. The primary presentation might be chest or interscapular pain, difficulty in breathing, and, in severe cases, hypotension. Considering the rapid deterioration of these patients’ clinical conditions, prompt diagnosis and treatment initiation are crucial. In these injuries, the most involved parts of the aorta are the isthmus (distal to the left subclavian artery) and the descending part in the thorax. Therefore, the main diagnostic strategies include transthoracic echocardiography, CT angiography, and endovascular diagnostic approaches. Case presentation The patient was a 19-year-old male presenting with the symptoms of chest pain, dyspnea, and extremities excruciating pain after a car turnover. The initial evaluation showed no abnormal cardiovascular finding except bilateral hemothorax, addressed with chest tubes. Twelve hours later, when the patient was under observation for orthopedic surgeries, his chest pain and dyspnea started, and TTE and CTA showed a grade three descending aneurysm of the aorta. The patient was treated immediately with an endovascular procedure of stent implantation. A delayed debranching surgery was also performed, which resulted in desirable outcomes and uneventful follow-up. Conclusion Although open thoracic surgery is the main and almost the only option for treating aneurysms of the aorta in hemodynamically unstable patients, the endovascular procedure has shown superior outcomes in selected patients with appropriate anatomy. Debranching surgery, which can be done simultaneously or with delay after the initial procedure, has proven protective against thromboembolic cerebral events. Clinical key point Patients with an aneurysm of the aorta should be transported to a medical center with a multidisciplinary team for an urgent evaluation and treatment. The initial resuscitation and diagnosis are challenging, considering the fatal nature of these injuries, and the selection of the treatment is based on the patient's clinical condition and evaluated anatomy in cardiovascular imaging.

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Section: Discussionmentioning

confidence: 99%

Successful management of a delayed presentation of traumatic descending thoracic aorta pseudoaneurysm: a literature review based on a case report

Sadeghian,

Ebrahimi,

Soltani

et al. 2024

Int J Emerg Med

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“…The enhanced CT is the imaging method of choice to follow-up, in short time, about 24 h, those patients with suspected vessel injury or with low-grade vessel injuries treated conservatively [ 9 , 32 , 33 , 34 , 35 , 36 , 37 ].…”

Section: Computed Tomography (Ct)mentioning

confidence: 99%

Non-Operative Management of Polytraumatized Patients: Body Imaging beyond CT

et al. 2023

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In the transition from the operative to the conservative approach for the polytraumatized patients who undergo blunt trauma, diagnostic imaging has assumed a pivotal role, currently offering various opportunities, particularly in the follow-up of these patients. The choice of the most suitable imaging method in this setting mainly depends on the injury complications we are looking for, the patient conditions (mobilization, cooperation, medications, allergies and age), the biological invasiveness, and the availability of each imaging method. Computed Tomography (CT) represents the “standard” imaging technique in the polytraumatized patient due to the high diagnostic performance when a correct imaging protocol is adopted, despite suffering from invasiveness due to radiation dose and intravenous contrast agent administration. Ultrasound (US) is a readily available technology, cheap, bedside performable and integrable with intravenous contrast agent (Contrast enhanced US—CEUS) to enhance the diagnostic performance, but it may suffer particularly from limited panoramicity and operator dependance. Magnetic Resonance (MR), until now, has been adopted in specific contexts, such as biliopancreatic injuries, but in recent experiences, it showed a great potential in the follow-up of polytraumatized patients; however, its availability may be limited in some context, and there are specific contraindications, such as as claustrophobia and the presence non-MR compatible devices. In this article, the role of each imaging method in the body-imaging follow-up of adult polytraumatized patients will be reviewed, enhancing the value of integrated imaging, as shown in several cases from our experience.

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The enigma of fine mobile structures on the aortic surface in a patient undergoing transcatheter aortic valve replacement: a case report

Cohen,

Saleb,

Troy

et al. 2024

European Heart Journal - Case Reports

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Background The surface of the aorta generally does not show motion unless mobile atheroma, thrombi, vegetations or intimal flaps are present. We previously described unusual mobile filamentous structures in the carotid artery. Here, we describe similar findings in the aorta and their possible cause. Case Summary An 88-year-old female with progressive exertional dyspnea and severe aortic stenosis (AS) had a successful trans-catheter aortic valve replacement (TAVR). A filamentous structure was noted on the focused pre-operative 2D TEE in the proximal descending aorta and post-TAVR as long strand-like structures attached to the thickened intimal wall with a planar component on 3D imaging. These findings were not associated with symptoms or clinical sequelae on short and long-term follow-up. Discussion The mobile structures that we describe are atypical for atheroma, thrombi, vegetations, and dissections in terms of their form and clinical presentation. 2D imaging showed that the filaments had focal thickening and emerged from the aortic surface. These findings suggest a relationship with the intima, perhaps from atherogenesis or injury with disruption or lifting of the intimal surface. No clinical sequelae were detected which may also relate to their position in the descending aorta and not the arch.

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Minimal Aortic Injury Detected on Computed Tomography Angiography during Initial Trauma Imaging: Single Academic Level 1 Trauma Center Experience

Cited by 3 publications

References 32 publications

Successful management of a delayed presentation of traumatic descending thoracic aorta pseudoaneurysm: a literature review based on a case report

Successful management of a delayed presentation of traumatic descending thoracic aorta pseudoaneurysm: a literature review based on a case report

Non-Operative Management of Polytraumatized Patients: Body Imaging beyond CT

The enigma of fine mobile structures on the aortic surface in a patient undergoing transcatheter aortic valve replacement: a case report

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