Overview of traumatic injury of the thoracic aorta.

Creasy, John D.; Chiles, Caroline; Routh, William D.; Dyer, Raymond B.

doi:10.1148/radiographics.17.1.9017797

Cited by 129 publications

(57 citation statements)

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“…On the other hand, 70 % of the patients with blunt aortic lesion who reach the hospital alive will survive, if given appropriate treatment. Development of coordinated emergency medical services using ground and air support, setting of dedicated trauma centers and recent advances in diagnostic modalities may allow for a prompt and accurate diagnosis and thus improve blunt trauma patients' outcome [1,13].…”

Section: Clinical Presentation and Prognosismentioning

confidence: 99%

“…Acute coarctation syndrome, relating to upper limb hypertension and lower limb decreased pulses and hypotension, as well as a precordial or interscapular systolic ejection murmur, is occasionally present. These symptoms and signs are neither sensitive nor specific [13,14]. In young patients with elastic chest walls involved in deceleration accidents, kinetic energy is absorbed by the intrathoracic viscera rather than by the thoracic cage itself.…”

Section: Clinical Presentation and Prognosismentioning

confidence: 99%

“…They are segmental in 55 % and circumferential in 45 % of cases. Aortic lesions may either be partial (65 %) or transmural (35 %) [3,13,17].…”

Section: Pathologymentioning

confidence: 99%

“…Bleeding from the aorta or from intramural vasa vasora generates a pseudo-aneurysm, which features a saccular pulsating outpouching, separated from the aortic lumen by a collar and limited by a thin layer of adventitia and by neighboring tissues, usually surrounded by a hemomediastinum. It may rupture at any moment [3,12,13,17].…”

Section: Pathologymentioning

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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Section: Clinical Presentation and Prognosismentioning

confidence: 99%

Section: Clinical Presentation and Prognosismentioning

confidence: 99%

“…They are segmental in 55 % and circumferential in 45 % of cases. Aortic lesions may either be partial (65 %) or transmural (35 %) [3,13,17].…”

Section: Pathologymentioning

confidence: 99%

Section: Pathologymentioning

confidence: 99%

See 2 more Smart Citations

Imaging of acute traumatic injuries of the thoracic aorta

2001

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“…Mosquera et al [7] reported that significant aortic regurgitation (AR) developed in 12% of patients with injuries at the ascending aorta as a consequence of the thoracic trauma. Proposed mechanisms that contribute to BAI include shearing forces, rapid deceleration, hydrostatic forces, and osseous pinch [8]. Rapid deceleration in the anteroposterior and lateral directions has been shown to be sufficient to result in cardiac displacement, producing torsion and shearing forces against the aorta at levels of relative immobility, mainly the ligamentum arteriosum, aortic root, and diaphragm [9].…”

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confidence: 99%