"Lumps" and "bumps" that mimic acute aortic and brachiocephalic vessel injury.

Fisher, Richard G.; Sanchez-Torres, M; Whigham, Cliff J.; Thomas, J W

doi:10.1148/radiographics.17.4.9225385

Cited by 39 publications

(22 citation statements)

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“…However, aortography is invasive, requires a special team for its performance, and is prone to both false-positive and false-negative results, rendering it a poor choice for screening. [296][297][298][299] CT is now the diagnostic test of choice. 285,287,[300][301][302][303][304] Other options for the diagnosis of blunt traumatic aortic injury include CXR, TEE, IVUS, and MRI.…”

Section: B Imaging Modalitiesmentioning

confidence: 99%

“…As mentioned, selective contrast aortography was long considered to be the reference standard examination for the diagnosis of traumatic aortic injury. Compared with necropsy, prior reports claimed sensitivity, specificity, and accuracy approaching 100%, 296,299,306 but with the introduction of CT and TEE, the failings of aortography became readily apparent. Indeed, modern CT and TEE are able to identify minimal injuries such as intimal tears, which constitute up to 10% of BAIs, whereas such injuries cannot be detected by contrast aortography.…”

Section: B Imaging Modalitiesmentioning

confidence: 99%

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Multimodality Imaging of Diseases of the Thoracic Aorta in Adults: From the American Society of Echocardiography and the European Association of Cardiovascular Imaging

Goldstein

Evangelista

Abbara

et al. 2015

Journal of the American Society of Echocardiography

543

434

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Section: B Imaging Modalitiesmentioning

confidence: 99%

Section: B Imaging Modalitiesmentioning

confidence: 99%

Multimodality Imaging of Diseases of the Thoracic Aorta in Adults: From the American Society of Echocardiography and the European Association of Cardiovascular Imaging

Goldstein

Evangelista

Abbara

et al. 2015

Journal of the American Society of Echocardiography

543

434

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“…It is located in the mid-descending aorta rather than at the aortic isthmus. It is associated with diffuse atherosclerotic disease [32,35]. Other pitfalls of aortography in the blunt traumatic aortic lesion are the large infundibula of aortic arch branch vessels and of intercostal arteries ± mainly the right bronchial±intercostal trunk, as well as unusual branching pat-435 Fig.…”

Section: Thoracic Aortography As a Gold Standard In Diagnosing Acute mentioning

confidence: 99%

“…(From [58]) terns of the aortic arch vessels [32,35]. The aortic spindle, which is a congenital narrowing of the aorta at the ligamentous arteriosum, has also to be mentioned with distal fusiform dilatation.…”

Section: Thoracic Aortography As a Gold Standard In Diagnosing Acute mentioning

confidence: 99%

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Imaging of acute traumatic injuries of the thoracic aorta

2001

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Epidemiology and biomechanicsBlunt injuries of the thoracic aorta are met in 0.5±2 % of chest trauma patients admitted in emergency rooms alive [1,2]. Aortic lesions represent the most lethal condition among chest injuries and are responsible for up to 40 % of fatalities occurring in traffic accidents [2,3]. Head-on and lateral motor vehicle accidents at speeds superior to 50 km/h, or associated with substantial car deformity, are the main cause (76 %) of blunt traumatic aortic injuries, followed by falls from heights ± usually exceeding 3 m ± and crush injuries [4,5,6,7].Four mechanisms are hypothesized to explain blunt lesions to the thoracic aorta [8,9]. Sudden antero-posterior or lateral deceleration superior to 80 g induces anterior cardiac displacement, leading to shearing forces, and sometimes rupture, at the aortic isthmic level [3,8]. Rapid vertical deceleration occurring in falls from height results in aortic arch compression against the anterior thoracic cage. Aortic injuries with such biomechanics are thus located on the ascending aorta [10]. The ªwater-hammer effectº relates to a low thoracic or abdominal compression. The resultant sudden increase of the intra-aortic pressure may be responsible for ascending aortic injuries immediately above the aortic valve. A pressure peak of 80±350 kPa (600±2500 mmHg) is required to rupture a normal aorta [5]. Finally, the ªos-seous pinchº hypothesis assumes a compression of the heart and the aorta between the sternum and vertebral column, for instance, under a violent frontal impact against the steering wheel. The resultant left posterior displacement of the heart generates an aortic torsion, which may result in a traumatic aortic lesion, sometimes associated with thoracic vertebral fractures [11]. Eur. Radiol. (2002) Abstract Blunt traumatic aortic injuries are a major concern in the settings of high-speed deceleration accidents, since they are associated with a very high mortality rate; however, with prompt diagnosis and surgery, 70 % of the patients with a blunt aortic lesion who reach the hospital alive will survive. This statement challenges the emergency radiologist in charge to evaluate the admission radiological survey in a severe chest trauma patient. With a 95 % negative predictive value for the identification of blunt traumatic aortic lesions, plain chest film represents an adequate screening test. If aortography remains the gold standard, it tends, at least in hemodynamically stable trauma patients, to be replaced by spiral-CT angiography (SCTA), which demonstrates a 96.2 % sensitivity, a 99.8 % specificity, and a 99.7 % accuracy. In unstable patients, trans-esophageal echography (TEE) plays a major diagnostic role. Knowledge of advantages and pitfalls of these imaging techniques, as reviewed in this article, will help the emergency radiologist to choose the appropriate algorithm in the diagnosis of traumatic aortic injury, for each trauma patient.Keywords Wounds and injuriesT horacic injuries´Aortic ruptureD iagnostic imaging´X-ray CTÉ mergency tr...

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