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Vasculature
Diagnosis
Arterial
Thoracic Aorta and Great Vessels
Traumatic Aortic Laceration
Traumatic Aortic Laceration
Terrance Healey, MD
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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)
            • Aortic transection
            • Blunt aortic injury (BAI)
            • Blunt aortic trauma (BAT)
            • Blunt traumatic aortic rupture (BTAR)
            • Traumatic aortic pseudoaneurysm

          • Definitions

            • Disruption or tear of aortic wall, usually from traumatic injury during motor vehicle collision (MVC), fall, or, less commonly, penetrating trauma
              • Partial tear vs. complete rupture

          IMAGING

          • General Features

            • Radiographic Findings

              • CT Findings

                • MR Findings

                  • Echocardiographic Findings

                    • Angiographic Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Gross Pathologic & Surgical Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. 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
                                          2. 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
                                          3. 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
                                          4. Kwolek CJ et al: Current management of traumatic thoracic aortic injury. Semin Vasc Surg. 23(4):215-20, 2010
                                          5. Morgan TA et al: Acute traumatic aortic injuries: posttherapy multidetector CT findings. Radiographics. 30(4):851-67, 2010
                                          6. Rojas CA et al: Mediastinal hematomas: aortic injury and beyond. J Comput Assist Tomogr. 33(2):218-24, 2009
                                          7. Steenburg SD et al: Acute traumatic aortic injury: imaging evaluation and management. Radiology. 248(3):748-62, 2008
                                          8. Anakwe RE: Traumatic aortic transection. Eur J Emerg Med. 12(3):133-5, 2005
                                          9. Pacini D et al: Traumatic rupture of the thoracic aorta: ten years of delayed management. J Thorac Cardiovasc Surg. 129(4):880-4, 2005
                                          10. Takahashi K et al: Multidetector CT of the thoracic aorta. Int J Cardiovasc Imaging. 21(1):141-53, 2005
                                          11. 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
                                          12. 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
                                          13. Neuhauser B et al: Stent-graft repair for acute traumatic thoracic aortic rupture. Am Surg. 70(12):1039-44, 2004
                                          14. Stamenkovic SA et al: Emergency endovascular stent grafting of a traumatic thoracic aortic dissection. Int J Clin Pract. 58(12):1165-7, 2004
                                          15. 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
                                          16. 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
                                          17. Richens D et al: The mechanism of injury in blunt traumatic rupture of the aorta. Eur J Cardiothorac Surg. 21(2):288-93, 2002
                                          18. Thompson CS et al: Acute traumatic rupture of the thoracic aorta treated with endoluminal stent grafts. J Trauma. 52(6):1173-7, 2002
                                          19. 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
                                          20. Fishman JE: Imaging of blunt aortic and great vessel trauma. J Thorac Imaging. 15(2):97-103, 2000
                                          21. Dyer DS et al: Can chest CT be used to exclude aortic injury? Radiology. 213(1):195-202, 1999
                                          22. 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
                                          23. 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
                                          24. Patel NH et al: Imaging of acute thoracic aortic injury due to blunt trauma: a review. Radiology. 209(2):335-48, 1998
                                          25. Ahrar K et al: Angiography in blunt thoracic aortic injury. J Trauma. 42(4):665-9, 1997
                                          26. 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
                                          27. 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)
                                                    • Aortic transection
                                                    • Blunt aortic injury (BAI)
                                                    • Blunt aortic trauma (BAT)
                                                    • Blunt traumatic aortic rupture (BTAR)
                                                    • Traumatic aortic pseudoaneurysm

                                                  • Definitions

                                                    • Disruption or tear of aortic wall, usually from traumatic injury during motor vehicle collision (MVC), fall, or, less commonly, penetrating trauma
                                                      • Partial tear vs. complete rupture

                                                  IMAGING

                                                  • General Features

                                                    • Radiographic Findings

                                                      • CT Findings

                                                        • MR Findings

                                                          • Echocardiographic Findings

                                                            • Angiographic Findings

                                                              • Imaging Recommendations

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Gross Pathologic & Surgical Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. 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
                                                                                  2. 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
                                                                                  3. 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
                                                                                  4. Kwolek CJ et al: Current management of traumatic thoracic aortic injury. Semin Vasc Surg. 23(4):215-20, 2010
                                                                                  5. Morgan TA et al: Acute traumatic aortic injuries: posttherapy multidetector CT findings. Radiographics. 30(4):851-67, 2010
                                                                                  6. Rojas CA et al: Mediastinal hematomas: aortic injury and beyond. J Comput Assist Tomogr. 33(2):218-24, 2009
                                                                                  7. Steenburg SD et al: Acute traumatic aortic injury: imaging evaluation and management. Radiology. 248(3):748-62, 2008
                                                                                  8. Anakwe RE: Traumatic aortic transection. Eur J Emerg Med. 12(3):133-5, 2005
                                                                                  9. Pacini D et al: Traumatic rupture of the thoracic aorta: ten years of delayed management. J Thorac Cardiovasc Surg. 129(4):880-4, 2005
                                                                                  10. Takahashi K et al: Multidetector CT of the thoracic aorta. Int J Cardiovasc Imaging. 21(1):141-53, 2005
                                                                                  11. 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
                                                                                  12. 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
                                                                                  13. Neuhauser B et al: Stent-graft repair for acute traumatic thoracic aortic rupture. Am Surg. 70(12):1039-44, 2004
                                                                                  14. Stamenkovic SA et al: Emergency endovascular stent grafting of a traumatic thoracic aortic dissection. Int J Clin Pract. 58(12):1165-7, 2004
                                                                                  15. 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
                                                                                  16. 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
                                                                                  17. Richens D et al: The mechanism of injury in blunt traumatic rupture of the aorta. Eur J Cardiothorac Surg. 21(2):288-93, 2002
                                                                                  18. Thompson CS et al: Acute traumatic rupture of the thoracic aorta treated with endoluminal stent grafts. J Trauma. 52(6):1173-7, 2002
                                                                                  19. 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
                                                                                  20. Fishman JE: Imaging of blunt aortic and great vessel trauma. J Thorac Imaging. 15(2):97-103, 2000
                                                                                  21. Dyer DS et al: Can chest CT be used to exclude aortic injury? Radiology. 213(1):195-202, 1999
                                                                                  22. 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
                                                                                  23. 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
                                                                                  24. Patel NH et al: Imaging of acute thoracic aortic injury due to blunt trauma: a review. Radiology. 209(2):335-48, 1998
                                                                                  25. Ahrar K et al: Angiography in blunt thoracic aortic injury. J Trauma. 42(4):665-9, 1997
                                                                                  26. 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
                                                                                  27. Gavant ML et al: Blunt traumatic aortic rupture: detection with helical CT of the chest. Radiology. 197(1):125-33, 1995