EURORAD ESR

Case 1331

Traumatic rupture of the thoracic aorta at the isthmus

Author(s)
F. Cademartiri, B.V. Salamousas, G. Luccichenti, P. Pavone
 
Patient
male, 46 year(s)

Clinical History

Deceleration car accident, with blunt thoracic trauma and unstable haemodynamics.

Imaging Findings

The patient was admitted following a consistent deceleration car accident. The patient was awake and the history and clinical examination were consistent with blunt trauma of the thorax. A CT scan had already been performed in another hospital and isthmic transection of the thoracic aorta was suspected. The patient was haemodynamically stabilised and then spiral CT was immediately performed.

Discussion

Rupture of the thoracic aorta is a lethal condition. Most patients die just after the accident and only a small number survive long enough to be admitted to hospital for primary care. Even though conventional DSA is considered to be the gold standard for the diagnosis of this condition, its application as a screening tool in all patients with blunt thoracic trauma is not feasible. Moreover it does not provide information about other thoracic structures which may be involved in the traumatic event.

Spiral CT has the potential to used as a screening tool for this purpose. One of the conditions needed for the diagnosis is a correct protocol of scan. In fact in this case it can be seen that the first spiral CT examination was performed with an incorrect protocol.

Final Diagnosis

Isthmic transection of the thoracic aorta
 

MeSH

  1. Aorta, Thoracic [A07.231.114.056.372]
    The portion of the descending aorta proceeding from the arch of the aorta and extending to the diaphragm.

References

  1. [1]
    Parker MS, Matheson TL, Rao AV, Sherbourne CD, Jordan KG, Landay MJ, Miller GL, Summa JA. Making the transition: the role of helical CT in the evaluation of potentially acute thoracic aortic injuries. AJR Am J Roentgenol. 2001;176(5):1267-72..

  2. [2]
    Gavant ML, Menke PG, Fabian T, Flick PA, Graney MJ, Gold RE. Blunt traumatic aortic rupture: detection with helical CT of the chest. Radiology 1995;197(1):125-33..

  3. [3]
    Durham RM, Zuckerman D, Wolverson M, Heiberg E, Luchtefeld WB, Herr DJ, Shapiro MJ, Mazuski JE, Salimi Z, Sundaram M. Computed tomography as a screening exam in patients with suspected blunt aortic injury. Ann Surg. 1994;220(5):699-704..

Citation

F. Cademartiri, B.V. Salamousas, G. Luccichenti, P. Pavone (2002, Jan 13).
Traumatic rupture of the thoracic aorta at the isthmus, {Online}.
URL: http://www.eurorad.org/case.php?id=1331
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  • Figure 1
    First CT scan performed in another hospital with 5mm collimation
    a b c  

    The aortic arch appears almost normal even if the beam-hardening artefacts from the superior vena cava disturb the image.

    At a lower level the beam-hardening artefacts are less apparent and the aortic arch seems normal.

    At the level of the tracheal carena the profile of the thoracic aorta is strange and not does not appear round. The lack of contrast medium inside the vessel makes it more difficult to assess the disease.

     
  • Figure 2
    Spiral CT at 3mm collimation in the same patient
    a b c d  

    There is a clear modification of the profile of the aortic arch with two flaps coming into the lumen.

    At the level of the tracheal carena the profile of the thoracic aorta is not rounded.

    At the level of the pulmonary artery bifurcation it is possible to see a clear dissection.

    The MPR along the sagittal plane displays clearly the aortic transection starting at the isthmus and determining a pseudoaneurysmatic modification.

     
Figure 1

First CT scan performed in another hospital with 5mm collimation

Figure 1a
The aortic arch appears almost normal even if the beam-hardening artefacts from the superior vena cava disturb the image.
 
Figure 1b
At a lower level the beam-hardening artefacts are less apparent and the aortic arch seems normal.
 
Figure 1c
At the level of the tracheal carena the profile of the thoracic aorta is strange and not does not appear round. The lack of contrast medium inside the vessel makes it more difficult to assess the disease.
 
Figure 2

Spiral CT at 3mm collimation in the same patient

Figure 2a
There is a clear modification of the profile of the aortic arch with two flaps coming into the lumen.
 
Figure 2b
At the level of the tracheal carena the profile of the thoracic aorta is not rounded.
 
Figure 2c
At the level of the pulmonary artery bifurcation it is possible to see a clear dissection.
 
Figure 2d
The MPR along the sagittal plane displays clearly the aortic transection starting at the isthmus and determining a pseudoaneurysmatic modification.
 
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