title: Periaortic contrast medium extravasation on chest CT in traumatic aortic injury: a sign for immediate thoracotomy.
abstract: Traumatic aortic injury (TAI) after blunt chest trauma is potentially a lethal condition. The injury must be diagnosed promptly and accurately. Evaluation for traumatic aortic injury begins with an assessment of mechanism of injury, a physical examination and chest radiography. In recent years, chest computed tomography (CT) has been advocated as a better screening tool to detect TAI but there is still controversial over the confirmatory diagnostic value of CT. For hemodynamically unstable patients in whom chest CT had shown direct sign of aortic injury and with periaortic contrast medium extravasation, we advocate that these patients should be operated on immediately without aortogram to avoid unnecessary delay. Herein, we describe a case of TAI with direct signs and periaortic contrast extravasation and discuss if chest CT can substitute an aortogram as a diagnostic tool when direct signs of TAI are revealed.
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital, 5 Fu-Hsin Street, Kweishan, Taoyuan 333, Taipei, Taiwan.
authors.forename: Y W
authors.initials: YW
authors.lastname: Shiau
authors.forename: Y C
authors.initials: YC
authors.lastname: Wong
authors.forename: C J
authors.initials: CJ
authors.lastname: Ng
authors.forename: J C
authors.initials: JC
authors.lastname: Chen
authors.forename: T F
authors.initials: TF
authors.lastname: Chiu
mesh_terms: D000063:Accidents, Traffic; D001011:Aorta / Q000293:injuries*; D001027:Aortography; D004630:Emergencies; D005119:Extravasation of Diagnostic and Therapeutic Materials; D006801:Humans; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000000981:diagnostic imaging* / Q000601:surgery; D013902:Radiography, Thoracic; D013898:Thoracic Injuries / Q000000981:diagnostic imaging* / Q000601:surgery; D013908:Thoracotomy; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000601:surgery