Blunt Traumatic Aortic Injury in the Pan‐scan Era

Yu, Lisa; Baumann, Brigitte M.; Raja, Ali S.; Mower, William R.; Langdorf, Mark I.; Medak, Anthony J.; Anglin, Deirdre; Hendey, Gregory W.; Nishijima, Daniel K.; Rodriguez, Robert M.

doi:10.1111/acem.13900

Cited by 10 publications

(11 citation statements)

References 19 publications

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“…An investigation that enrolled 24,010 BTAI patients reported that most patients had chest injury, with rib fractures and pulmonary contusion occurring most frequently. [12] In a nationwide case series, Sheehan et al [13] discovered that rib fractures, spine fractures, a nd trunk abrasion were risk factors for blunt abdominal aortic injury (BAAI). Moreover, previous research has found that MVAs are a common cause of traumatic aortic injury.…”

Section: Discussionmentioning

confidence: 99%

Analysis of imaging characteristics of blunt traumatic aortic dissection: an 8-year experience

Li¹,

Lin²,

Lü³

2022

World Journal of Emergency Medicine

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BACKGROUND: Traumatic aortic dissection (TAD) has a low incidence but extremely high mortality. It always presents atypical clinical manifestations that are easily missed or misdiagnosed. This study mainly aims to describe the imaging characteristics and management of TAD patients. METHODS:A retrospective analysis of 27 blunt TAD patients was performed between 2013 and 2020. Demographic features, imaging characteristics, and management were analyzed.RESULTS: Twenty-seven patients with type B aortic dissection (age 56.04±16.07 years, 20 men) were included. Aortic intimal tears were mostly initiated from the aortic isthmus. The sizes of the proximal intimal tears in the greater curvature were larger than those in the lesser curvature (1.78±0.56 cm vs. 1.24±0.52 cm, P=0.031). Compared with those in the control group, the maximum diameters of the aortic arch, thoracic aorta, and abdominal aorta in the TAD patients were all significantly widened (all P<0.050). Multivariate logistic regression analysis showed that the maximum diameter of the thoracic aorta was an independent risk factor for TAD, with a predictive value with an area under the receiver operating characteristic curve (AUC) of 0.673. Finally, 26 patients successfully underwent delayed thoracic endovascular aortic repair (TEVAR), and the remaining one patient was treated conservatively. No progression of aortic dissection or death occurred during the six-month follow-up period. CONCLUSIONS:In blunt trauma, the aortic isthmus is the most common site of proximal intimal tears. An accurate diagnosis of TAD requires an overall consideration of medical history and imaging characteristics. Delayed TEVAR might be an eff ective therapeutic option for TAD.

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Section: Discussionmentioning

confidence: 99%

Analysis of imaging characteristics of blunt traumatic aortic dissection: an 8-year experience

Li¹,

Lin²,

Lü³

2022

World Journal of Emergency Medicine

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“…BTAI is a clinically rare but fatal condition ( 17 ). RFs serve as a chief risk factor for BTAI ( 18 , 19 ). The retrospective study by Choi et al showed that RFs contributed to approximately 22.9% of all closed TAI cases ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

The clinical characteristics and surgical treatment for delayed blunt thoracic aortic injury—a case series

Wang¹,

Wu²,

Guo³

et al. 2022

J Thorac Dis

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Background: Delayed thoracic aortic injury (DTAI) induced by left closed rib fractures (RFs) is a clinically rare blunt injury to the thoracic aorta with an insidious onset. DTAI is very prone to missed diagnosis due to the unreliability of using the initial post-injury computed tomography (CT) scan to explicitly detect any signs of an aortic injury, potentially leading to a fatal hemorrhage. Timely diagnosis and treatment are therefore key to preventing such deadly complications. With that said, not all cases of left RFs lead to delayed aortic injuries, so how can surgeons tell which cases are to be culled and focused on? Also, what kinds of treatment should be administered upon detection? Methods: A retrospective analysis was performed on the clinical data of DTAI cases induced by left closed RF that were admitted to our Hospital from June 2015 through June 2020. Injuries to the aortic tunica adventitia or the elastic layer were intraoperatively confirmed. CT scan findings, locations and numbers of RFs, as well as the choices of surgical procedure were reviewed postoperatively. In addition, a literature review was conducted to analyze characteristics shared by similar cases.Results: This study included 7 patients treated by our hospital and 8 reported in the literature. The broken ends of RFs causing aortic wall injury (including the tunica adventitia) were all found in the medial to the lateral erector spinae. All patients in our hospital received internal fixation for RFs and thoracoscopic removal of free bone fragments (if any). Concomitant injuries were managed either by simultaneous or staged surgery.Conclusions: For multiple left RFs with the broken ends located in the inside of the lateral erector spinae, the number of fractured ribs ≥4 and a smaller number of fractured ribs with multiple fractures in a single rib are important factors for DTAI. Active surgical intervention is recommended for patients with these important factors. The specific intervention is tailored to each patient's particular needs to eliminate the risk of developing life-threatening thoracic aortic injury (TAI) and rupture.

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“…Vascular injury is diagnosed by CTA scan imaging, as the classic findings of widened mediastinum and hemopneumothorax on a screening CXR are not sensitive [17]. Inaba et al [18] identified 3 types of aortic disruptionhemodynamically unstable full thickness laceration, symptomatic intimal dissection with occlusion, and asymptomatic intimal dissection without occlusion.…”

Section: Discussionmentioning

confidence: 99%

Aortic Impingement in Displaced Traumatic Spine Fracture with Complete Spinal Cord Transection: A Case Report

et al. 2021

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Aortic impingement associated with traumatic thoracic spinal fractures is a rare and potentially lethal complication that creates management challenges in an already complex clinical problem. Traumatic aortic injury is one of the leading causes of death in blunt trauma. Magerl divided thoracic and lumbar fractures into 3 categories; the primary focus of this report, type C fractures, describes rotational injury and is one of the less common types, especially associated with aortic impingement as such. In this case, a young man was admitted following a near-fatal fall resulting in blunt force trauma to the midthoracic region. Emergency CT revealed a type C complete transection at the level of T11 and a grade I aortic injury. Definitive fixation of the spinal injury was delayed in favor of preventing further vascular injury by prioritizing the securing of hemodynamic stability. In traumatic thoracolumbar injuries, blunt traumatic aortic injury is often managed conservatively. However, blunt thoracic aortic injury is one of the leading causes of death from trauma, and each case requires its own case-by-case multidisciplinary management. In this occasion, management of the vascular insult was paramount to ensuring patient survival and favorable outcome.

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Blunt Traumatic Aortic Injury in the Pan‐scan Era

Cited by 10 publications

References 19 publications

Analysis of imaging characteristics of blunt traumatic aortic dissection: an 8-year experience

Analysis of imaging characteristics of blunt traumatic aortic dissection: an 8-year experience

The clinical characteristics and surgical treatment for delayed blunt thoracic aortic injury—a case series

Aortic Impingement in Displaced Traumatic Spine Fracture with Complete Spinal Cord Transection: A Case Report

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