Prospective study of blunt aortic injury: helical CT is diagnostic and antihypertensive therapy reduces rupture.

OBJECTIVE There were two aims of this study. The first was to evaluate the application of helical computed tomography of the thorax (HCTT) for the diagnosis of blunt aortic injury (BAI). The second was to evaluate the efficacy of beta-blockers with or without nitroprusside in preventing aortic rupture. SUMMARY BACKGROUND DATA Aortography has been the standard for diagnosing BAI for the past 4 decades. Conventional chest CT has not proven to be of significant value. Helical CT scanning is faster and has higher resolution than conventional CT. Retrospective studies have suggested the efficacy of antihypertensives in preventing aortic rupture. METHODS A prospective study comparing HCTT to aortography in the diagnosis of BAI was performed. A protocol of beta-blockers with or without nitroprusside was also examined for efficacy in preventing rupture before aortic repair and in allowing delayed repair in patients with significant associated injuries. RESULTS Over a period of 4 years, 494 patients were studied. BAI was diagnosed in 71 patients. Sensitivity was 100% for HCTT versus 92% for aortography. Specificity was 83% for HCTT versus 99% for aortography. Accuracy was 86% for HCTT versus 97% for aortography. Positive predictive value was 50% for HCTT versus 97% for aortography. Negative predictive value was 100% for HCTT versus 97% for aortography. No patient had spontaneous rupture in this study. CONCLUSIONS HCTT is sensitive for diagnosing intimal injuries and pseudoaneurysms. Patients without direct HCTT evidence of BAI require no further evaluation. Aortography can be reserved for indeterminate HCTT scans. Early diagnosis with HCTT and presumptive treatment with the antihypertensive regimen eliminated in-hospital aortic rupture.

[1]  D. Hankins,et al.  Thoracic aortography following blunt chest trauma. , 1990, The American journal of emergency medicine.

[2]  H. A. Thomas,et al.  Role of CT in diagnosis of major arterial injury after blunt thoracic trauma. , 1989, Surgery.

[3]  S. Shackford,et al.  Computed tomography in the diagnosis of traumatic rupture of the thoracic aorta. , 1989, Clinical radiology.

[4]  R. Scorpio,et al.  Value of CT in determining the need for angiography when findings of mediastinal hemorrhage on chest radiographs are equivocal. , 1991, AJR. American journal of roentgenology.

[5]  M. Wolverson,et al.  CT in aortic trauma. , 1983, AJR. American journal of roentgenology.

[6]  McLean Tr,et al.  Computed tomography in the evaluation of the aorta in patients sustaining blunt chest trauma. , 1991 .

[7]  S. Ross,et al.  Traumatic disruptions of the thoracic aorta: treatment and outcome. , 1990, Surgery.

[8]  M. Glickman,et al.  Traumatic aortic rupture: false-positive aortographic diagnosis due to atypical ductus diverticulum. , 1988, AJR. American journal of roentgenology.

[9]  L. Goodman,et al.  Evaluation of traumatic aortic injury: does dynamic contrast-enhanced CT play a role? , 1992, Radiology.

[10]  C. Zarins,et al.  Use of CT for diagnosis of traumatic rupture of the thoracic aorta , 1993, Annals of vascular surgery.

[11]  K. Mattox,et al.  Conservative management of aortic lacerations due to blunt trauma. , 1990, The Journal of trauma.

[12]  G. Vlahakes,et al.  Blunt injuries of the thoracic aorta. , 1992, The Annals of thoracic surgery.

[13]  M. Metzler,et al.  Computed tomographic evaluation to exclude traumatic aortic disruption. , 1992, The Journal of trauma.

[14]  P. Menke,et al.  CT aortography of thoracic aortic rupture. , 1996, AJR. American journal of roentgenology.

[15]  C. White,et al.  Traumatic aortic injury: diagnosis with contrast-enhanced thoracic CT--five-year experience at a major trauma center. , 1996, Radiology.

[16]  W Flynn,et al.  Prospective study of blunt aortic injury: Multicenter Trial of the American Association for the Surgery of Trauma. , 1997, The Journal of trauma.

[17]  T. Fabian,et al.  Blunt traumatic aortic rupture: detection with helical CT of the chest. , 1995, Radiology.

[18]  B. Boulanger,et al.  Traumatic rupture of the thoracic aorta: Should one always operate immediately? , 1995, Annals of vascular surgery.

[19]  V. Raptopoulos,et al.  Traumatic aortic tear: screening with chest CT. , 1992, Radiology.

[20]  R. Fisher,et al.  "Lumps" and "bumps" that mimic acute aortic and brachiocephalic vessel injury. , 1997, Radiographics.

[21]  G. J. Crystal,et al.  Thoracic aortic trauma: role of dynamic CT. , 1991, Radiology.

[22]  A. Conn,et al.  Acute traumatic disruption of the thoracic aorta: emergency department management. , 1992, Annals of emergency medicine.

[23]  M. Kerstein,et al.  Role of computed tomography scan in evaluating the widened mediastinum. , 1994, The American surgeon.

[24]  Y. Nakajima,et al.  The role of CT in traumatic rupture of the thoracic aorta and its proximal branches. , 1989, Seminars in roentgenology.

[25]  M. Wolverson,et al.  Computed tomography as a screening exam in patients with suspected blunt aortic injury. , 1994 .

[26]  W. Daggett,et al.  Acute traumatic disruption of the thoracic aorta: a ten-year experience. , 1981, The Annals of thoracic surgery.

[27]  S. Mirvis,et al.  Role of CT in excluding major arterial injury after blunt thoracic trauma. , 1987, AJR. American journal of roentgenology.

[28]  Smith Dc,et al.  Transesophageal echocardiography in the diagnosis of traumatic rupture of the aorta. , 1995, The New England journal of medicine.

[29]  M. Chasen,et al.  Diagnosis of injuries of the aorta and brachiocephalic arteries caused by blunt chest trauma: CT vs aortography. , 1994, AJR. American journal of roentgenology.