Experience with spiral computed tomography as the sole diagnostic method for traumatic aortic rupture

Background. Spiral computed tomographic (CT) scan is an excellent screen fo r aortic trauma. Traditionally, aortography is performed when injury is sus pected to confirm the diagnosis. We hypothesized that it is safe and expedi tious to forgo aortography when the spiral CT demonstrates aortic injury. Methods. Retrospective review of 54 patients undergoing aortic repair from July 1994 to December 1999. Spiral CT was the initial diagnostic study in 5 2 patients. Pseudoaneurysm or aortic wall defect in the presence of mediast inal hematoma was considered diagnostic. Angiography, initially routine, wa s later performed only when requested by the surgeon, and for all "nonnegat ive" studies (periaortic hematoma without detectable aortic injury). Results. Twenty-six patients underwent angiography before operation (group 1). Nineteen group 1 spiral CTs were unequivocally diagnostic; 7 were nonne gative and angiography was required. Twenty-eight other patients underwent repair based on spiral CT alone (group 2). There was one false-positive res ult in both groups. There were no unexpected operative findings. Mean time from admission to diagnosis was 5.7 +/- 3.4 hours for group 1 and 1.7 +/- 1 .7 hours for group 2 (p < 0.01). Conclusions. Operating on the basis of a diagnostic spiral CT is safe and e xpeditious. Aortography may be reserved for those with equivocal studies. ( C) 2001 by The Society of Thoracic Surgeons.