DIAGNOSIS OF INJURIES OF THE AORTA AND BRACHIOCEPHALIC ARTERIES CAUSED BY BLUNT CHEST TRAUMA - CT VS AORTOGRAPHY

OBJECTIVE. The purpose of this study was to evaluate the role of chest CT in the triage of patients with potential injuries of the aorta and brachiocephalic arteries caused by blunt trauma and to test the value of chest CT scans in limiting the number of screening aortograms. SUB JECTS AND METHODS. A prospective study was done with 107 patients who were examined because of possible laceration of the aorta or brachioce phalic vessels. Chest radiographs were obtained in 107 patients, aorto grams in 105, and chest CT scans in 90. This evaluation concentrates o n the 88 patients who had both CT and aortography. Findings on CT scan s were categorized as normal, equivocal, suggestive of, subtly positiv e for, or grossly positive for mediastinal hematoma. RESULTS. Findings on CT scans were considered normal in 18 patients. Sixteen had normal aortographic findings. Two of the 18 had clinical follow-up without a ortography. Findings on CT scans were considered equivocal in 25 patie nts, suggestive of hematoma in 13, subtly positive for hematoma in 24, and grossly positive for hematoma in 10. Subsequent aortography showe d injuries in four patients who had abnormal CT findings. Nineteen oth er patients had aortography because of grossly abnormal findings on ch est radiographs, and one aortic injury was detected. CONCLUSION. The v alue of chest CT as a preliminary procedure to avoid thoracic aortogra phy in patients with blunt trauma was limited in our series. Chest CT scans with normal findings effectively exclude aortic/brachiocephalic injury; however, only about 25% of our patients had chest CT scans wit h unequivocally normal findings, and most patients required further ev aluation with aortography.