Traumatic aortic tear: screening with chest CT.

Abstract

Dynamic chest computed tomography (CT) was performed in 326 patients who had undergone abdominal CT for blunt trauma to evaluate the role of chest CT in screening for thoracic aortic injury. Evidence of mediastinal bleeding constituted an abnormal CT examination. The results were correlated with those from aortography in 131 patients. The chest radiographs were abnormal in 127 patients (39%). Of those 127 patients, chest CT scans were abnormal in 39 patients; an aortic tear was present in eight of those patients (21%). The remaining 88 patients had normal CT scans and no aortic injury. Of the 199 patients with normal radiographs, 15 had abnormal CT scans and 184 had normal CT scans and no aortic injury. There were no false-negative CT scans; 79% of patients with normal CT scans had false-positive chest radiographs. With CT there was a significant improvement over plain radiography in specificity, accuracy, and predictive value of positive results. If chest CT were used as an adjunct to chest radiography in the screening for traumatic aortic tear, the need for aortography would decrease by 56%. Chest CT can safely help discriminate candidates for aortography, is cost-effective, and, in hemodynamically stable patients, should be incorporated in the screening for traumatic aortic tear.

Imaging blunt traumatic aortic injury: a Canadian tertiary care trauma centre case series

“…[14][15][16] In contrast to previous studies 15, 16 , we had no false negatives in our small dataset.…”

Vascular Trauma: New Directions in Screening, Diagnosis and Management

“…Detection of these few patients has long been a subject of debate. Chest x-ray is the primary screening exam, however, it can be normal in up to 44% of patients with TAI, and positive findings are nonspecific (Demetriades, et al, 1998;Raptopoulos, et al, 1992;Woodring. 1990).…”

“…Multi-detector helical scanners now have the ability to acquire more data in less time (20-35 seconds), with improved definition, and MIP and 3-dimensional reconstruction has allowed even greater anatomical accuracy. Modern series reliably report sensitivity between 95-100% (Bruckner, et al, 2006;Dyer, et al, 2000;Exadaktylos, et al, 2005;Fisher, et al, 1994;Raptopoulos, et al, 1992;Wintermark, et al, 2002). Specificity, initially a drawback ranging from 83-86% (Fabian, et al, 1998;Raptopoulos, et al, 1992), has improved with modern technology as well and now ranges between 94-99.8% (Mirvis & Shanmuganathan.…”

“…Modern series reliably report sensitivity between 95-100% (Bruckner, et al, 2006;Dyer, et al, 2000;Exadaktylos, et al, 2005;Fisher, et al, 1994;Raptopoulos, et al, 1992;Wintermark, et al, 2002). Specificity, initially a drawback ranging from 83-86% (Fabian, et al, 1998;Raptopoulos, et al, 1992), has improved with modern technology as well and now ranges between 94-99.8% (Mirvis & Shanmuganathan. 2007;Wintermark, et al, 2002;Wong, et al, 2004).…”

“…Given these benefits some investigators have advocated abandoning chest x-ray as a screening tool in favor of CT in all patients with blunt thoracic trauma. CT's done for this purpose will reveal injuries in 5-25% of patients with normal x-rays, but will lead to a change in management in ≤ 6% of cases (Barrios, et al, 2009;Kaiser, et al, 2011;Raptopoulos, et al, 1992). Although chest x-ray may miss up to 7-8% of TAI, use of CT as a screening tool indiscriminately is unlikely to be productive or cost effective and may result in unnecessary radiation exposure with attendant increase in cancer risk (Demetriades, et al, 1998;Kaiser, et al, 2011;Melton, et al, 2004).…”