title: Blunt thoracic aortic injuries: CT characterisation and treatment outcomes of minor injury.
abstract: OBJECTIVE
  Computed tomography (CT)-defined anatomical differentiation of minor and major blunt traumatic aortic injuries (TAIs) was applied to determine injury grade and management/outcomes in minor TAIs, and if the presence of peri-aortic mediastinal haematoma (MH) correlated with TAI grade.
  
  
  METHODS
  Admission chest CT of blunt TAI cases during 2005-2011 were reviewed by consensus and categorised as major or minor. Minor was defined as pseudoaneurysm <10 % normal aortic lumen, intimal flap or contour abnormality. Presence/absence of MH was determined. Clinical management/outcome was ascertained from medical records.
  
  
  RESULTS
  Of 115 TAIs, 42 were minor (33 with MH, 9 without). Among the 73 with major TAI, 3 had no MH. Twenty-six (62 %) minor TAI patients were managed medically, 12 (29 %) percutaneous stent-grafts, 2 (5 %) died of non-aortic causes and 2 (5 %) underwent surgery. Of 26 managed without intervention, none developed complications from TAI at last clinical or CT follow-up. The relationship between presence/absence of peri-aortic MH and grade of TAI was statistically significant.
  
  
  CONCLUSIONS
  More than a third of multi-detector (MD) CT-diagnosed TAIs were minor. Minor TAIs treated medically were stable at last follow-up, suggesting this is a reasonable initial management approach. Absence of MH cannot be relied upon to exclude minor TAI, indicating the need for careful direct aortic inspection.
  
  
  CONCLUSIONS
  • MDCT can differentiate minor from major blunt traumatic aortic injuries. • About one-third of MDCT-diagnosed blunt traumatic aortic injuries are minor. • Minor aortic injuries are not necessarily accompanied by mediastinal haemorrhage. • MDCT diagnosis of minor aortic injury supports application of medical management.
authors.affiliation: Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, 22 South Greene Street, Baltimore, MD, 21201, USA.
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Forman
authors.forename: Stuart E
authors.initials: SE
authors.lastname: Mirvis
authors.forename: David S
authors.initials: DS
authors.lastname: Hollander
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006406:Hematoma / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D006801:Humans; D008297:Male; D008477:Mediastinal Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D008875:Middle Aged; D061330:Multidetector Computed Tomography / Q000379:methods*; D009104:Multiple Trauma; D012189:Retrospective Studies; D013898:Thoracic Injuries / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D016896:Treatment Outcome; D057772:Vascular System Injuries / Q000150:complications / Q000000981:diagnostic imaging* / Q000601:surgery; D051598:Whole Body Imaging / Q000379:methods*; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000601:surgery; D055815:Young Adult