Intravascular sonography in the assessment of traumatic injury of the thoracic aorta

OBJECTIVE, The objective of this study is to describe the use of intravascu lar sonography in the evaluation of suspected injury of the thoracic aorta as an adjunctive tool to digital subtraction arteriography (DSA). SUBJECTS AND METHODS. Images of the thoracic aorta were obtained using DSA and intravascular sonography in 20 consecutive patients who underwent arter iography after chest trauma. A B-French, 12.5-MHz sonography catheter was u sed for the intravascular sonography study, Diagnoses based on the review o f both studies were compared, RESULTS, Five of 20 patients had aortic or great vessel injuries confirmed by surgery. Intravascular sonographic findings were positive (one false-pos itive) in seven patients, whereas DSA findings were positive in six patient s (one false-positive and one false-negative). Surgery showed the lesion th at was false-positive using both techniques to be a ductus diverticulum. In travascular sonographic findings included intimal flaps, intramural lesions (hematomas), pseudoaneurysms, and perivascular hematomas. CONCLUSION. In our initial limited experience, intravascular sonography of the thoracic aorta and great vessels effectively identified traumatic injur ies. Intramural injury without pseudoaneurysm formation or obvious intralum inal flap was visualized by intravascular sonography in one patient but was not detected by DSA, On the other hand, a ductus diverticulum was erroneou sly interpreted as trauma using both techniques. Intravascular sonography i s a relatively new procedure with an obvious learning curve in the interpre tation of the findings. An atypical ductus diverticulum may still be mistak enly interpreted as a sign of traumatic injury of the aorta. Familiarity wi th intravascular sonography in the setting of aortic trauma is necessary fo r correct interpretation of the images. The sonographic findings offer view s of the aorta that are complementary to those of aortography.