Blunt thoracic aortic injuries: CT characterisation and treatment outcomes of minor injury.

OBJECTIVES: 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. KEY POINTS: • 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.