TRAUMATIC AORTIC RUPTURE - DEMONSTRATION BY MAGNETIC-RESONANCE-IMAGING

Traumatic rupture of the aorta is a major cause of morbidity and morta lity in rapid deceleration road traffic accidents, with an immediate m ortality of 85%. Of the 15% that survive the initial injury, approxima tely 50% will die within 24 h if left untreated. Prompt diagnosis and early surgical treatment are necessary if such patients are to survive . Aortography is the standard investigation of choice and provides a r apid, sensitive test of aortic rupture. Other modalities, such as plai n chest radiography, computed tomography (CT) and ultrasound may also play a role in diagnosis. Magnetic resonance imaging (MRI), with its m ulti-planar imaging capability, is now widely used for imaging non-tra umatic disorders of the aorta. However, its use in traumatic rupture h as been limited by difficulties in monitoring and in access to the pat ient during the scan. We present a patient who survived the initial in jury, when the diagnosis of aortic rupture was not suspected, and pres ented 3 weeks later with chest pain. An MRI scan was feasible as the p atient was haemodynamically stable, and it provided an elegant non-inv asive means of diagnosis, so that aortography was not necessary in thi s case. Although aortography is likely to remain the investigation of choice in the acute situation, MRI is a useful alternative in selected cases.