CT AORTOGRAPHY OF THORACIC AORTIC RUPTURE

OBJECTIVE. Emergent aortography is commonly used to confirm and define a suspected thoracic aortic rupture detected by CT screening. We eval uated whether helical CT aortography can replace transcatheter aortogr aphy for critically injured patients. SUBJECTS AND METHODS. Over 22 mo nths, 38 thoracic aorta and great vessel injuries were detected in 322 9 patients with nontrivial blunt chest trauma who underwent helical CT screening. Planar, oblique, and curved two-dimensional reconstruction s and three-dimensional shaded-surface display and maximum intensity p rojection volume-rendering techniques were used to evaluate the aortic injuries. Transcatheter aortography or surgery was performed in all s table patients. RESULTS. Twenty-eight of the injuries involved the des cending thoracic aorta. All such injuries were best identified on axia l images before CT angiography. CT angiography adequately showed tears over 15 mm long. Smaller tears required axial images for corroboratio n. CONCLUSION. Technically adequate axial helical CT detects and defin es all injuries of the thoracic aorta, CT angiography supplements the conventional examination and can replace transcatheter aortography exc ept for small tears or indeterminate studies.