Diagnostic imaging of traumatic pseudoaneurysm of the thoracic aorta
Background. The purpose of the study was the presentation of findings and diagnostic imaging in patients with traumatic pseudoaneurysms of the thoracic aorta, as a rare consequence of road traffic accidents.
Patients and methods. In 22 years we have found 8 traumatic pseudoaneurysms of the thoracic aorta, out of which 7 (87.5%) in male and 1 (12.5%) in female patients. At the time of accidents the youngest patient was 21 and the oldest was 55 (mean age 33.8 years), and at the moment of diagnosing a pseudoaneurysm they were 26 and 55 years old, respectively (mean age 38.7 years). In all patients chest radiography was performed as well as CT scan, in 6 (75%) patients intra-venous digital subtraction angiography was performed (i.v. DSA) and in 1 (12.5%) MRI. CT was performed with the application of 120 ml, and i.v. DSA with 60 ml of contrast medium, respectively.
Results. In 8 (100%) patients, who suffered a road traffic accident, and whose chest radiograph showed the enlargement of the aortic knob and widening of the mediastinum, CT, i.v. DSA and MRI revealed a traumatic pseudoaneurysm of the thoracic aorta. Periods of time between the accidents and the initial diagnosis of the pseudoaneurysm varied from 7 days to 18 years (median 2.0 years). The diameter of the pseudoaneurysm was from 4.5 to 9.2 cm (median 5.5 cm). In 7 (87.5%) isthmus was involved, and in 1 (12.5%) descending thoracic aorta, respectively. The chest radiograph revealed marginal calcifications in 4 (50%), and on the CT in 5 (62.5%) patients. Intraluminal thrombosis was found by CT in 2(25%) traumatized patients.
Conclusions. Traumatic pseudoaneurysm should be taken into consideration in blunt chest trauma, where a chest radiograph shows suspicious regions. A multislice CT is a diagnostic method of choice.
Strassman G. Traumatic rupture of the aorta. Am Heart J 1947; 33: 508-15.
Greendyke RM. Traumatic rupture of aorta; special reference to automobile accidents. JAMA 1966; 195: 527-30.
O'Conor CE. Diagnosing traumatic rupture of the thoracic aorta in the emergency department. Emerg Med J 2004; 21: 414-9.
Sutton D, Gregson RHS. Arteriography and interventional angiography. In: Sutton D, editor. Radiology. Churchill Livingston: Elsevier; 2003. p. 425-6.
Alkadhi H, Wildermuth S, Desbiolles L, Schertler T, Crook D, Marincek B, et al. Vascular emergencies of the thorax after blunt and iatrogenic trauma: multi-detector row CT and three-dimensional imaging. Radiographics 2004; 24: 1239-55.
Chai P, Mohiaddin R. Traumatic pseudoaneurysm of the descending thoracic aorta. Circulation 2005; 112: e260-1.
Roques X. Chronic post-traumatic aneurysms of the thoracic aorta. [French]. Rev Prat 1991; 41: 1789-92.
Heystraten FM, Rosenbusch G, Kingma LM, Lacquet LK. Chronic posttraumatic aneurysm of the thoracic aorta: surgically correctable occult threat. AJR Am J Roentgenol 1986; 146: 303-8.
Rogers FB. Traumatic laceration of the aorta. N Engl J Med 2004, 351: 1239.
Fraser RS, Colman N, Muller NL, Pare PD. Synopsis of diseases of the chest. Third edition. Philadelphia: Elselvier-Saunders; 2005. p. 796-9.
Downing SW, Sperling JS, Mirvis SE, Cardarelli MG, Gilbert TB, Scalea TM, et al. Experience with spiral computed tomography as the sole diagnostic method for traumatic aortic rupture. Ann Thorac Surg 2001; 72: 495-501.
Wicky S, Capasso P, Meuli R, Fischer A, von Segesser L, Schnyder P. Spiral CT aortography: an efficient technique for the diagnosis of traumatic aortic injury. Eur Radiol 1998; 8: 828-33
Gjikolli B, Hadzihasanovic B, Jaganjac S, Herceglija E, Niksic M, Hadzimehmedagic A, et al. Treatment of complicated case with subclavia steal syndrome and stenosis of common iliac artery. Radiol Oncol 2008; 42: 1-12.
Pavlisa G, Ozretic D, Rados M, Pavlisa G. Migration of Enterprise stent in treatment of intracranial aneurysms: a report of two cases. Radiol Oncol 2009; 43: 233-9.
Lebl DR, Dicker RA, Spain DA, Brundage SI. Dramatic shift in the primary management of traumatic thoracic aortic rupture. Arch Surg 2006; 141: 177-80.