TRAUMATIC AORTIC INJURY - DIAGNOSIS WITH CONTRAST-ENHANCED THORACIC CT - 5-YEAR EXPERIENCE AT A MAJOR TRAUMA CENTER

PURPOSE: To review the literature and the authors' experience with adm ission contrast material-enhanced computed tomography (CT) in patients admitted after blunt trauma. MATERIALS AND METHODS: From January 1990 to December 1994, thoracic CT was performed to evaluate traumatic aor tic injury in 677 patients with positive or equivocal findings at ches t radiography. CT scans positive for mediastinal hemorrhage or aortic injury were retrospectively reviewed and interpreted by consensus, wit h angiographic and surgical confirmation. RESULTS: CT findings were ne gative for TAI in 570 (84%) of the 677 patients. Mediastinal hemorrhag e was reported in 100 patients and was the only abnormality in 79 of t hem. Findings at angiography were negative for traumatic aortic injury in 77 (97%). CT signs of traumatic aortic injury in 21 patients inclu ded contour abnormality or pseudoaneurysm (n = 19), intimal flap(s) (n = 8), and pseudocoarctation (n = 3). Findings at angiography were pos itive for traumatic aortic injury in 19 (90%). For aortic injury and m ediastinal hemorrhage, respectively, specificity for traumatic aortic injury was 99% and 87% and sensitivity was 90% and 100%; at meta-analy sis of data from the authors and the literature, sensitivity was 97.0% and 99.3% and specificity was 99.8% and 87.1%. Reliance on findings a t admission CT rather than radiography to indicate suspicion for traum atic aortic injury before angiography resulted in savings of more than $365,000. CONCLUSION: The CT finding of mediastinal hemorrhage alone is sensitive for traumatic aortic injury, but the finding of aortic in jury is more specific.