CASE 1331 Published on 12.01.2002

Traumatic rupture of the thoracic aorta at the isthmus

Section

Cardiovascular

Case Type

Clinical Cases

Authors

F. Cademartiri, B.V. Salamousas, G. Luccichenti, P. Pavone

Patient

46 years, male

Categories

No Area of Interest ; Imaging Technique CT, CT

No Procedure ; No Special Focus ;

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Clinical History

Deceleration car accident, with blunt thoracic trauma and unstable haemodynamics.

Imaging Findings

The patient was admitted following a consistent deceleration car accident. The patient was awake and the history and clinical examination were consistent with blunt trauma of the thorax. A CT scan had already been performed in another hospital and isthmic transection of the thoracic aorta was suspected. The patient was haemodynamically stabilised and then spiral CT was immediately performed.

Discussion

Rupture of the thoracic aorta is a lethal condition. Most patients die just after the accident and only a small number survive long enough to be admitted to hospital for primary care. Even though conventional DSA is considered to be the gold standard for the diagnosis of this condition, its application as a screening tool in all patients with blunt thoracic trauma is not feasible. Moreover it does not provide information about other thoracic structures which may be involved in the traumatic event.

Spiral CT has the potential to used as a screening tool for this purpose. One of the conditions needed for the diagnosis is a correct protocol of scan. In fact in this case it can be seen that the first spiral CT examination was performed with an incorrect protocol.

Differential Diagnosis List

Isthmic transection of the thoracic aorta

Final Diagnosis

Isthmic transection of the thoracic aorta

References

[1] Parker MS, Matheson TL, Rao AV, Sherbourne CD, Jordan KG, Landay MJ, Miller GL, Summa JA. Making the transition: the role of helical CT in the evaluation of potentially acute thoracic aortic injuries. AJR Am J Roentgenol. 2001;176(5):1267-72. (PMID: 11312193)

[2] Gavant ML, Menke PG, Fabian T, Flick PA, Graney MJ, Gold RE. Blunt traumatic aortic rupture: detection with helical CT of the chest. Radiology 1995;197(1):125-33. (PMID: 7568809)

[3] Durham RM, Zuckerman D, Wolverson M, Heiberg E, Luchtefeld WB, Herr DJ,
Shapiro MJ, Mazuski JE, Salimi Z, Sundaram M. Computed tomography as a screening exam in patients with suspected blunt aortic injury. Ann Surg. 1994;220(5):699-704. (PMID: 7979620)

Case information

URL:	https://eurorad.org/case/1331
DOI:	10.1594/EURORAD/CASE.1331
ISSN:	1563-4086

Figure 1

First CT scan performed in another hospital with 5mm collimation

The aortic arch appears almost normal even if the beam-hardening artefacts from the superior vena cava disturb the image.

At a lower level the beam-hardening artefacts are less apparent and the aortic arch seems normal.

At the level of the tracheal carena the profile of the thoracic aorta is strange and not does not appear round. The lack of contrast medium inside the vessel makes it more difficult to assess the disease.

Figure 2

Spiral CT at 3mm collimation in the same patient