Traumatic aortic injury: Diagnosis with contrast-enhanced thoracic CT - Five-year experience at a major trauma center

PURPOSE: To review the literature and the authors' experience with admission contrast material-enhanced computed tomography (CT) in patients admitted after blunt trauma. MATERIALS AND METHODS: From January 1990 to December 1994, thoracic CT was performed to evaluate traumatic aortic injury in 677 patients with positive or equivocal findings at chest radiography. CT scans positive for mediastinal hemorrhage or aortic injury were retrospectively reviewed and interpreted by consensus, with angiographic and surgical confirmation. RESULTS: CT findings were negative for TAI in 570 (84%) of the 677 patients. Mediastinal hemorrhage was reported in 100 patients and was the only abnormality in 79 of them. Findings at angiography were negative for traumatic aortic injury in 77 (97%). CT signs of traumatic aortic injury in 21 patients included contour abnormality or pseudoaneurysm (n = 19), intimal flap(s) (n = 8), and pseudocoarctation (n = 3). Findings at angiography were positive for traumatic aortic injury in 19 (90%). For aortic injury and mediastinal hemorrhage, respectively, specificity for traumatic aortic injury was 99% and 87% and sensitivity was 90% and 100%; at meta-analysis of data from the authors and the literature, sensitivity was 97.0% and 99.3% and specificity was 99.8% and 87.1%. Reliance on findings at admission CT rather than radiography to indicate suspicion for traumatic aortic injury before angiography resulted in savings of more than $365,000. CONCLUSION: The CT finding of mediastinal hemorrhage alone is sensitive for traumatic aortic injury, but the finding of aortic injury is more specific.