CT aortography of thoracic aortic rupture

OBJECTIVE. Emergent aortography is commonly used to confirm and define a suspected thoracic aortic rupture detected by CT screening. We evaluated whether helical CT aortography can replace transcatheter aortography for critically injured patients. SUBJECTS AND METHODS. Over 22 months, 38 thoracic aorta and great vessel injuries were detected in 3229 patients with nontrivial blunt chest trauma who underwent helical CT screening. Planar, oblique, and curved two-dimensional reconstructions and three-dimensional shaded-surface display and maximum intensity projection volume-rendering techniques were used to evaluate the aortic injuries. Transcatheter aortography or surgery was performed in all stable patients. RESULTS. Twenty-eight of the injuries involved the descending thoracic aorta. All such injuries were best identified on axial images before CT angiography. CT angiography adequately showed tears over 15 mm long. Smaller tears required axial images for corroboration. CONCLUSION. Technically adequate axial helical CT detects and defines all injuries of the thoracic aorta, CT angiography supplements the conventional examination and can replace transcatheter aortography except for small tears or indeterminate studies.