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Aortic Injury
Hank Baskin, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Traumatic aortic injury (TAI), blunt aortic injury (BAI), blunt thoracic aortic injury (BTAI)
              • Definitions

                • Intramural hematoma: Isolated circumferential or crescentic thickening of aortic wall without intimal injury
                • Intimal tear: Small, isolated injury to intimal layer of aorta without external aortic contour abnormality → linear intimal defect &/or associated thrombus < 10 mm
                • Large intimal flap: Larger intimal injury than tear but still without external aortic contour abnormality → linear intimal defect &/or associated thrombus > 10 mm
                • Pseudoaneurysm: Rupture contained by adventitia → focal outpouching of aortic lumen causing external aortic contour abnormality
                • Rupture: Uncontained dissection causing external aortic contour abnormality with extraluminal contrast (extravasation)

              IMAGING

              • General Features

                • Radiographic Findings

                  • CT Findings

                    • MR Findings

                      • Ultrasonographic Findings

                        • Echocardiographic Findings

                          • Angiographic Findings

                            • Imaging Recommendations

                              DIFFERENTIAL DIAGNOSIS

                                PATHOLOGY

                                • General Features

                                  • Staging, Grading, & Classification

                                    CLINICAL ISSUES

                                    • Presentation

                                      • Demographics

                                        • Natural History & Prognosis

                                          • Treatment

                                            DIAGNOSTIC CHECKLIST

                                            • Consider

                                              Selected References

                                              1. Mouawad NJ et al: Blunt thoracic aortic injury - concepts and management. J Cardiothorac Surg. 15(1):62, 2020
                                              2. Nicholas NW et al: Pictorial review on the endovascular management of paediatric aortic injuries. Br J Radiol. 93(1106):20190017, 2020
                                              3. Akhmerov A et al: Blunt thoracic aortic injury: current therapies, outcomes, and challenges. Ann Vasc Dis. 12(1):1-5, 2019
                                              4. Hasjim BJ et al: National trends of thoracic endovascular aortic repair versus open thoracic aortic repair in pediatric blunt thoracic aortic injury. Ann Vasc Surg. 59:150-7, 2019
                                              5. Scalea TM et al: Blunt Thoracic aortic injury: endovascular repair is now the standard. J Am Coll Surg. 228(4):605-10, 2019
                                              6. Golden J et al: Limiting chest computed tomography in the evaluation of pediatric thoracic trauma. J Trauma Acute Care Surg. 81(2):271-7, 2016
                                              7. Gutierrez A et al: The utility of chest X-ray as a screening tool for blunt thoracic aortic injury. Injury. 47(1):32-6, 2016
                                              8. Heneghan RE et al: Call for a new classification system and treatment strategy in blunt aortic injury. J Vasc Surg. 64(1):171-6, 2016
                                              9. Brinkman AS et al: Evolution in management of adolescent blunt aortic injuries--a single institution 22-y experience. J Surg Res. 193(2):523-7, 2015
                                              10. Tashiro J et al: Mechanism and mortality of pediatric aortic injuries. J Surg Res. 198(2):456-61, 2015
                                              11. Starnes BW et al: A new classification scheme for treating blunt aortic injury. J Vasc Surg. 55(1):47-54, 2012
                                              12. Aladham F et al: Traumatic aortic injury: computerized tomographic findings at presentation and after conservative therapy. J Comput Assist Tomogr. 34(3):388-94, 2010
                                              13. Barmparas G et al: Pediatric vs adult vascular trauma: a National Trauma Databank review. J Pediatr Surg. 45(7):1404-12, 2010
                                              14. Pabon-Ramos WM et al: Radiologic evaluation of blunt thoracic aortic injury in pediatric patients. AJR Am J Roentgenol. 194(5):1197-203, 2010
                                              15. Moore MA et al: The imaging of paediatric thoracic trauma. Pediatr Radiol. 39(5):485-96, 2009
                                              16. Takagi H et al: Endovascular versus open repair for blunt thoracic aortic injury. Ann Thorac Surg. 87(1):349-50, 2009
                                              17. Bruckner BA et al: Critical evaluation of chest computed tomography scans for blunt descending thoracic aortic injury. Ann Thorac Surg. 81(4):1339-46, 2006
                                              18. Murala JS et al: Traumatic rupture of the aorta in children--stenting or surgical intervention? A word of caution. J Thorac Cardiovasc Surg. 132(3):731-2; author reply 732, 2006
                                              19. Heckman SR et al: Risk factors for blunt thoracic aortic injury in children. J Pediatr Surg. 40(1):98-102, 2005
                                              20. Milas ZL et al: Pediatric blunt trauma resulting in major arterial injuries. Am Surg. 70(5):443-7, 2004
                                              21. McGwin G Jr et al: Incidence and characteristics of motor vehicle collision-related blunt thoracic aortic injury according to age. J Trauma. 52(5):859-65; discussion 865-6, 2002
                                              22. Lowe LH et al: Traumatic aortic injuries in children: radiologic evaluation. AJR Am J Roentgenol. 170(1):39-42, 1998
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Top Differential Diagnoses

                                                    • Pathology

                                                      • Clinical Issues

                                                        • Diagnostic Checklist

                                                          TERMINOLOGY

                                                          • Abbreviations

                                                            • Traumatic aortic injury (TAI), blunt aortic injury (BAI), blunt thoracic aortic injury (BTAI)
                                                          • Definitions

                                                            • Intramural hematoma: Isolated circumferential or crescentic thickening of aortic wall without intimal injury
                                                            • Intimal tear: Small, isolated injury to intimal layer of aorta without external aortic contour abnormality → linear intimal defect &/or associated thrombus < 10 mm
                                                            • Large intimal flap: Larger intimal injury than tear but still without external aortic contour abnormality → linear intimal defect &/or associated thrombus > 10 mm
                                                            • Pseudoaneurysm: Rupture contained by adventitia → focal outpouching of aortic lumen causing external aortic contour abnormality
                                                            • Rupture: Uncontained dissection causing external aortic contour abnormality with extraluminal contrast (extravasation)

                                                          IMAGING

                                                          • General Features

                                                            • Radiographic Findings

                                                              • CT Findings

                                                                • MR Findings

                                                                  • Ultrasonographic Findings

                                                                    • Echocardiographic Findings

                                                                      • Angiographic Findings

                                                                        • Imaging Recommendations

                                                                          DIFFERENTIAL DIAGNOSIS

                                                                            PATHOLOGY

                                                                            • General Features

                                                                              • Staging, Grading, & Classification

                                                                                CLINICAL ISSUES

                                                                                • Presentation

                                                                                  • Demographics

                                                                                    • Natural History & Prognosis

                                                                                      • Treatment

                                                                                        DIAGNOSTIC CHECKLIST

                                                                                        • Consider

                                                                                          Selected References

                                                                                          1. Mouawad NJ et al: Blunt thoracic aortic injury - concepts and management. J Cardiothorac Surg. 15(1):62, 2020
                                                                                          2. Nicholas NW et al: Pictorial review on the endovascular management of paediatric aortic injuries. Br J Radiol. 93(1106):20190017, 2020
                                                                                          3. Akhmerov A et al: Blunt thoracic aortic injury: current therapies, outcomes, and challenges. Ann Vasc Dis. 12(1):1-5, 2019
                                                                                          4. Hasjim BJ et al: National trends of thoracic endovascular aortic repair versus open thoracic aortic repair in pediatric blunt thoracic aortic injury. Ann Vasc Surg. 59:150-7, 2019
                                                                                          5. Scalea TM et al: Blunt Thoracic aortic injury: endovascular repair is now the standard. J Am Coll Surg. 228(4):605-10, 2019
                                                                                          6. Golden J et al: Limiting chest computed tomography in the evaluation of pediatric thoracic trauma. J Trauma Acute Care Surg. 81(2):271-7, 2016
                                                                                          7. Gutierrez A et al: The utility of chest X-ray as a screening tool for blunt thoracic aortic injury. Injury. 47(1):32-6, 2016
                                                                                          8. Heneghan RE et al: Call for a new classification system and treatment strategy in blunt aortic injury. J Vasc Surg. 64(1):171-6, 2016
                                                                                          9. Brinkman AS et al: Evolution in management of adolescent blunt aortic injuries--a single institution 22-y experience. J Surg Res. 193(2):523-7, 2015
                                                                                          10. Tashiro J et al: Mechanism and mortality of pediatric aortic injuries. J Surg Res. 198(2):456-61, 2015
                                                                                          11. Starnes BW et al: A new classification scheme for treating blunt aortic injury. J Vasc Surg. 55(1):47-54, 2012
                                                                                          12. Aladham F et al: Traumatic aortic injury: computerized tomographic findings at presentation and after conservative therapy. J Comput Assist Tomogr. 34(3):388-94, 2010
                                                                                          13. Barmparas G et al: Pediatric vs adult vascular trauma: a National Trauma Databank review. J Pediatr Surg. 45(7):1404-12, 2010
                                                                                          14. Pabon-Ramos WM et al: Radiologic evaluation of blunt thoracic aortic injury in pediatric patients. AJR Am J Roentgenol. 194(5):1197-203, 2010
                                                                                          15. Moore MA et al: The imaging of paediatric thoracic trauma. Pediatr Radiol. 39(5):485-96, 2009
                                                                                          16. Takagi H et al: Endovascular versus open repair for blunt thoracic aortic injury. Ann Thorac Surg. 87(1):349-50, 2009
                                                                                          17. Bruckner BA et al: Critical evaluation of chest computed tomography scans for blunt descending thoracic aortic injury. Ann Thorac Surg. 81(4):1339-46, 2006
                                                                                          18. Murala JS et al: Traumatic rupture of the aorta in children--stenting or surgical intervention? A word of caution. J Thorac Cardiovasc Surg. 132(3):731-2; author reply 732, 2006
                                                                                          19. Heckman SR et al: Risk factors for blunt thoracic aortic injury in children. J Pediatr Surg. 40(1):98-102, 2005
                                                                                          20. Milas ZL et al: Pediatric blunt trauma resulting in major arterial injuries. Am Surg. 70(5):443-7, 2004
                                                                                          21. McGwin G Jr et al: Incidence and characteristics of motor vehicle collision-related blunt thoracic aortic injury according to age. J Trauma. 52(5):859-65; discussion 865-6, 2002
                                                                                          22. Lowe LH et al: Traumatic aortic injuries in children: radiologic evaluation. AJR Am J Roentgenol. 170(1):39-42, 1998