Michelle Jennifer Forman MD, Presenter: Nothing to Disclose

Stuart E. Mirvis MD, Abstract Co-Author: Nothing to Disclose

The purpose of this study was to determine the percentage of all patients sustaining CT-diagnosed blunt traumatic aortic injury (TAI) with minor injuries, the extent of associated mediastinal hemorrhage (MH), and clinical outcome of minor TAI treated without intervention.

After IRB approval, the authors collected all cases of blunt TAI from our instititution's trauma and radiology registries from 2005 to 2011. For this retrospective study, admission chest CT was reviewed for each patient and categorized as major or minor TAI. Minor TAI included focal aortic contour abnormality, wall thickening, intimal flap(s), and/or shallow pseudoaneurysm. MH extent was graded as 0, 1 or 2 corresponding to absent, periaortic only, or more extensive. All follow-up CTs of patients with minor TAI were reviewed. Chart review for all minor TAI determined patient demographics, initial management and outcome at last follow-up. 

There were 107 TAIs of which 36% (39/107) were minor. Among minor TAIs, 77% (30/39) had no MH (16) or limited to the periaortic region (14). Conversely, only 32% (22/68) of those with major TAI had no MH (2) or limited to the periaortic region (20). Of those with minor TAI, 54% (21/39) were managed without intervention, 31% (12/39) had percutaneous stent-grafts, 10% (4/39) died of non-aortic causes, and 5% (2/39) had surgery. Of 21 patients managed without intervention, none developed complications related to TAI at last follow-up. Nineteen of 21 patients had at least one follow-up CT. 

Minor TAI from blunt trauma are seen more commonly as CT technology progresses. More than one-third of all TAIs in this series were minor, with over half managed without intervention. Most minor injuries had no or little associated MH as opposed to major TAIs with more extensive hemorrhage commonly present. Therefore, minor TAIs would rarely be suggested by an abnormal mediastinal contour on chest radiography and can be subtle even by contemporary CTangiography. All patients with minor injuries managed without intervention were stable at last follow-up indicating this is a reasonable management approach. The optimal number and timing of follow-up CTs to document injury stability or resolution is uncertain.

Minor blunt TAI are not uncommonly seen using MDCT-A, are typically associated with no or minimal mediastinal hematoma and are successfully managed without intervention.

Forman, M, Mirvis, S, Minor Traumatic Thoracic Aortic Injuries:  CT Characterization and Treatment Outcomes.  Radiological Society of North America 2011 Scientific Assembly and Annual Meeting, November 26 - December 2, 2011 ,Chicago IL. http://archive.rsna.org/2011/11003466.html