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Traumatic Aortic Injury
Allen Heeger, DO
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Clinical Issues

          TERMINOLOGY

          • Abbreviations

            • Traumatic aortic injury (TAI)
          • Synonyms

            • Acute traumatic aortic injury (ATAI)
            • Blunt traumatic aortic injury (BTAI)
            • Aortic transection
            • Blunt aortic injury (BAI)
            • Blunt traumatic aortic rupture (BTAR)
            • Traumatic aortic pseudoaneurysm
          • Definitions

            • Aortic wall disruption: Ranges from intimomedial injury to transection
              • Most commonly from blunt, rapid deceleration injury: Motor vehicle collision (MVC), fall from height > 10 feet
              • Less commonly: Penetrating trauma
            • Minimal aortic injury: Subcentimeter intimomedial abnormality, no external contour deformity
            • Traumatic aortic pseudoaneurysm: Saccular outpouching contained only by adventitia

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • MR Findings

                  • Echocardiographic Findings

                    • Angiographic Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              • Gross Pathologic & Surgical Features

                                CLINICAL ISSUES

                                • Presentation

                                  • Demographics

                                    • Natural History & Prognosis

                                      • Treatment

                                        DIAGNOSTIC CHECKLIST

                                        • Consider

                                          • Image Interpretation Pearls

                                            • Reporting Tips

                                              Selected References

                                              1. Kapoor H et al: Minimal aortic injury: mechanisms, imaging manifestations, natural history, and management. Radiographics. 40(7):1834-47, 2020
                                              2. Yu L et al: Blunt Traumatic aortic injury in the pan-scan era. Acad Emerg Med. 27(4):291-6, 2020
                                              3. Akhmerov A et al: Blunt thoracic aortic injury: current therapies, outcomes, and challenges. Ann Vasc Dis. 12(1):1-5, 2019
                                              4. Hahn LD et al: Cross-sectional imaging of thoracic traumatic aortic injury. Vasa. 48(1):6-16, 2019
                                              5. Patel NR et al: Pearls and pitfalls in imaging of blunt traumatic thoracic aortic injury: a pictorial review. Br J Radiol. 91(1089):20180130, 2018
                                              6. Tsai R et al: Traumatic abdominal aortic injury: clinical considerations for the diagnostic radiologist. Abdom Radiol (NY). 43(5):1084-93, 2018
                                              7. Wojciechowski J et al: Traumatic aortic injury: does the anatomy of the aortic arch influence aortic trauma severity? Surg Today. 47(3):328-34, 2017
                                              8. Shan JG et al: Thoracic endovascular aortic repair for traumatic thoracic aortic injury: a single-center initial experience. Ann Vasc Surg. 32:104-10, 2016
                                              9. Kaiser ML et al: Risk factors for traumatic injury findings on thoracic computed tomography among patients with blunt trauma having a normal chest radiograph. Arch Surg. 146(4):459-63, 2011
                                              10. 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
                                              11. Berger FH et al: Acute aortic syndrome and blunt traumatic aortic injury: pictorial review of MDCT imaging. Eur J Radiol. 74(1):24-39, 2010
                                              12. Kwolek CJ et al: Current management of traumatic thoracic aortic injury. Semin Vasc Surg. 23(4):215-20, 2010
                                              13. Morgan TA et al: Acute traumatic aortic injuries: posttherapy multidetector CT findings. Radiographics. 30(4):851-67, 2010
                                              14. Rojas CA et al: Mediastinal hematomas: aortic injury and beyond. J Comput Assist Tomogr. 33(2):218-24, 2009
                                              15. Steenburg SD et al: Acute traumatic aortic injury: imaging evaluation and management. Radiology. 248(3):748-62, 2008
                                              16. Anakwe RE: Traumatic aortic transection. Eur J Emerg Med. 12(3):133-5, 2005
                                              17. Pacini D et al: Traumatic rupture of the thoracic aorta: ten years of delayed management. J Thorac Cardiovasc Surg. 129(4):880-4, 2005
                                              18. Takahashi K et al: Multidetector CT of the thoracic aorta. Int J Cardiovasc Imaging. 21(1):141-53, 2005
                                              19. Alkadhi H et al: Vascular emergencies of the thorax after blunt and iatrogenic trauma: multi-detector row CT and three-dimensional imaging. Radiographics. 24(5):1239-55, 2004
                                              20. Kondo N et al: Surgical repair for chronic traumatic thoracic aneurysm after 12-year follow-up. Jpn J Thorac Cardiovasc Surg. 52(12):586-8, 2004
                                              21. Neuhauser B et al: Stent-graft repair for acute traumatic thoracic aortic rupture. Am Surg. 70(12):1039-44, 2004
                                              22. Stamenkovic SA et al: Emergency endovascular stent grafting of a traumatic thoracic aortic dissection. Int J Clin Pract. 58(12):1165-7, 2004
                                              23. Wong H et al: Periaortic hematoma at diaphragmatic crura at helical CT: sign of blunt aortic injury in patients with mediastinal hematoma. Radiology. 231(1):185-9, 2004
                                              24. Czermak BV et al: Placement of endovascular stent-grafts for emergency treatment of acute disease of the descending thoracic aorta. AJR Am J Roentgenol. 179(2):337-45, 2002
                                              25. Richens D et al: The mechanism of injury in blunt traumatic rupture of the aorta. Eur J Cardiothorac Surg. 21(2):288-93, 2002
                                              26. Thompson CS et al: Acute traumatic rupture of the thoracic aorta treated with endoluminal stent grafts. J Trauma. 52(6):1173-7, 2002
                                              27. Dyer DS et al: Thoracic aortic injury: how predictive is mechanism and is chest computed tomography a reliable screening tool? A prospective study of 1,561 patients. J Trauma. 48(4):673-82; discussion 682-3, 2000
                                              28. Fishman JE: Imaging of blunt aortic and great vessel trauma. J Thorac Imaging. 15(2):97-103, 2000
                                              29. Dyer DS et al: Can chest CT be used to exclude aortic injury? Radiology. 213(1):195-202, 1999
                                              30. Fishman JE et al: Direct versus indirect signs of traumatic aortic injury revealed by helical CT: performance characteristics and interobserver agreement. AJR Am J Roentgenol. 172(4):1027-31, 1999
                                              31. Fabian TC et al: Prospective study of blunt aortic injury: helical CT is diagnostic and antihypertensive therapy reduces rupture. Ann Surg. 227(5):666-76; discussion 676-7, 1998
                                              32. Mirvis SE et al: Use of spiral computed tomography for the assessment of blunt trauma patients with potential aortic injury. J Trauma. 45(5):922-30, 1998
                                              33. Patel NH et al: Imaging of acute thoracic aortic injury due to blunt trauma: a review. Radiology. 209(2):335-48, 1998
                                              34. Ahrar K et al: Angiography in blunt thoracic aortic injury. J Trauma. 42(4):665-9, 1997
                                              35. Mirvis SE et al: Traumatic aortic injury: diagnosis with contrast-enhanced thoracic CT--five-year experience at a major trauma center. Radiology. 200(2):413-22, 1996
                                              36. Gavant ML et al: Blunt traumatic aortic rupture: detection with helical CT of the chest. Radiology. 197(1):125-33, 1995
                                              Related Anatomy
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                                              Related Differential Diagnoses
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                                              References
                                              Tables

                                              Tables

                                              KEY FACTS

                                              • Terminology

                                                • Imaging

                                                  • Top Differential Diagnoses

                                                    • Clinical Issues

                                                      TERMINOLOGY

                                                      • Abbreviations

                                                        • Traumatic aortic injury (TAI)
                                                      • Synonyms

                                                        • Acute traumatic aortic injury (ATAI)
                                                        • Blunt traumatic aortic injury (BTAI)
                                                        • Aortic transection
                                                        • Blunt aortic injury (BAI)
                                                        • Blunt traumatic aortic rupture (BTAR)
                                                        • Traumatic aortic pseudoaneurysm
                                                      • Definitions

                                                        • Aortic wall disruption: Ranges from intimomedial injury to transection
                                                          • Most commonly from blunt, rapid deceleration injury: Motor vehicle collision (MVC), fall from height > 10 feet
                                                          • Less commonly: Penetrating trauma
                                                        • Minimal aortic injury: Subcentimeter intimomedial abnormality, no external contour deformity
                                                        • Traumatic aortic pseudoaneurysm: Saccular outpouching contained only by adventitia

                                                      IMAGING

                                                      • General Features

                                                        • Radiographic Findings

                                                          • CT Findings

                                                            • MR Findings

                                                              • Echocardiographic Findings

                                                                • Angiographic Findings

                                                                  • Imaging Recommendations

                                                                    DIFFERENTIAL DIAGNOSIS

                                                                      PATHOLOGY

                                                                      • General Features

                                                                        • Staging, Grading, & Classification

                                                                          • Gross Pathologic & Surgical Features

                                                                            CLINICAL ISSUES

                                                                            • Presentation

                                                                              • Demographics

                                                                                • Natural History & Prognosis

                                                                                  • Treatment

                                                                                    DIAGNOSTIC CHECKLIST

                                                                                    • Consider

                                                                                      • Image Interpretation Pearls

                                                                                        • Reporting Tips

                                                                                          Selected References

                                                                                          1. Kapoor H et al: Minimal aortic injury: mechanisms, imaging manifestations, natural history, and management. Radiographics. 40(7):1834-47, 2020
                                                                                          2. Yu L et al: Blunt Traumatic aortic injury in the pan-scan era. Acad Emerg Med. 27(4):291-6, 2020
                                                                                          3. Akhmerov A et al: Blunt thoracic aortic injury: current therapies, outcomes, and challenges. Ann Vasc Dis. 12(1):1-5, 2019
                                                                                          4. Hahn LD et al: Cross-sectional imaging of thoracic traumatic aortic injury. Vasa. 48(1):6-16, 2019
                                                                                          5. Patel NR et al: Pearls and pitfalls in imaging of blunt traumatic thoracic aortic injury: a pictorial review. Br J Radiol. 91(1089):20180130, 2018
                                                                                          6. Tsai R et al: Traumatic abdominal aortic injury: clinical considerations for the diagnostic radiologist. Abdom Radiol (NY). 43(5):1084-93, 2018
                                                                                          7. Wojciechowski J et al: Traumatic aortic injury: does the anatomy of the aortic arch influence aortic trauma severity? Surg Today. 47(3):328-34, 2017
                                                                                          8. Shan JG et al: Thoracic endovascular aortic repair for traumatic thoracic aortic injury: a single-center initial experience. Ann Vasc Surg. 32:104-10, 2016
                                                                                          9. Kaiser ML et al: Risk factors for traumatic injury findings on thoracic computed tomography among patients with blunt trauma having a normal chest radiograph. Arch Surg. 146(4):459-63, 2011
                                                                                          10. 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
                                                                                          11. Berger FH et al: Acute aortic syndrome and blunt traumatic aortic injury: pictorial review of MDCT imaging. Eur J Radiol. 74(1):24-39, 2010
                                                                                          12. Kwolek CJ et al: Current management of traumatic thoracic aortic injury. Semin Vasc Surg. 23(4):215-20, 2010
                                                                                          13. Morgan TA et al: Acute traumatic aortic injuries: posttherapy multidetector CT findings. Radiographics. 30(4):851-67, 2010
                                                                                          14. Rojas CA et al: Mediastinal hematomas: aortic injury and beyond. J Comput Assist Tomogr. 33(2):218-24, 2009
                                                                                          15. Steenburg SD et al: Acute traumatic aortic injury: imaging evaluation and management. Radiology. 248(3):748-62, 2008
                                                                                          16. Anakwe RE: Traumatic aortic transection. Eur J Emerg Med. 12(3):133-5, 2005
                                                                                          17. Pacini D et al: Traumatic rupture of the thoracic aorta: ten years of delayed management. J Thorac Cardiovasc Surg. 129(4):880-4, 2005
                                                                                          18. Takahashi K et al: Multidetector CT of the thoracic aorta. Int J Cardiovasc Imaging. 21(1):141-53, 2005
                                                                                          19. Alkadhi H et al: Vascular emergencies of the thorax after blunt and iatrogenic trauma: multi-detector row CT and three-dimensional imaging. Radiographics. 24(5):1239-55, 2004
                                                                                          20. Kondo N et al: Surgical repair for chronic traumatic thoracic aneurysm after 12-year follow-up. Jpn J Thorac Cardiovasc Surg. 52(12):586-8, 2004
                                                                                          21. Neuhauser B et al: Stent-graft repair for acute traumatic thoracic aortic rupture. Am Surg. 70(12):1039-44, 2004
                                                                                          22. Stamenkovic SA et al: Emergency endovascular stent grafting of a traumatic thoracic aortic dissection. Int J Clin Pract. 58(12):1165-7, 2004
                                                                                          23. Wong H et al: Periaortic hematoma at diaphragmatic crura at helical CT: sign of blunt aortic injury in patients with mediastinal hematoma. Radiology. 231(1):185-9, 2004
                                                                                          24. Czermak BV et al: Placement of endovascular stent-grafts for emergency treatment of acute disease of the descending thoracic aorta. AJR Am J Roentgenol. 179(2):337-45, 2002
                                                                                          25. Richens D et al: The mechanism of injury in blunt traumatic rupture of the aorta. Eur J Cardiothorac Surg. 21(2):288-93, 2002
                                                                                          26. Thompson CS et al: Acute traumatic rupture of the thoracic aorta treated with endoluminal stent grafts. J Trauma. 52(6):1173-7, 2002
                                                                                          27. Dyer DS et al: Thoracic aortic injury: how predictive is mechanism and is chest computed tomography a reliable screening tool? A prospective study of 1,561 patients. J Trauma. 48(4):673-82; discussion 682-3, 2000
                                                                                          28. Fishman JE: Imaging of blunt aortic and great vessel trauma. J Thorac Imaging. 15(2):97-103, 2000
                                                                                          29. Dyer DS et al: Can chest CT be used to exclude aortic injury? Radiology. 213(1):195-202, 1999
                                                                                          30. Fishman JE et al: Direct versus indirect signs of traumatic aortic injury revealed by helical CT: performance characteristics and interobserver agreement. AJR Am J Roentgenol. 172(4):1027-31, 1999
                                                                                          31. Fabian TC et al: Prospective study of blunt aortic injury: helical CT is diagnostic and antihypertensive therapy reduces rupture. Ann Surg. 227(5):666-76; discussion 676-7, 1998
                                                                                          32. Mirvis SE et al: Use of spiral computed tomography for the assessment of blunt trauma patients with potential aortic injury. J Trauma. 45(5):922-30, 1998
                                                                                          33. Patel NH et al: Imaging of acute thoracic aortic injury due to blunt trauma: a review. Radiology. 209(2):335-48, 1998
                                                                                          34. Ahrar K et al: Angiography in blunt thoracic aortic injury. J Trauma. 42(4):665-9, 1997
                                                                                          35. Mirvis SE et al: Traumatic aortic injury: diagnosis with contrast-enhanced thoracic CT--five-year experience at a major trauma center. Radiology. 200(2):413-22, 1996
                                                                                          36. Gavant ML et al: Blunt traumatic aortic rupture: detection with helical CT of the chest. Radiology. 197(1):125-33, 1995