Abdominal Radiology

, Volume 43, Issue 5, pp 1084–1093 | Cite as

Traumatic abdominal aortic injury: clinical considerations for the diagnostic radiologist

  • Richard Tsai
  • Demetrios Raptis
  • Constantine Raptis
  • Vincent M. Mellnick
Article
  • 48 Downloads

Abstract

Traumatic abdominal aortic injury (TAAI) is a severe complication of penetrating and blunt trauma with significant morbidity and mortality, particularly if diagnosis is delayed. In patients with life-threatening injuries, accurate and prompt diagnosis of TAAI can be made with computed tomography (CT). Once the diagnosis of TAAI is made, the radiologist should provide an accurate description of the aortic lesion and the extent of injury in order to guide management whether it be non-operative, open aortic repair, or endoluminal stent repair. The purpose of this article is to review the key imaging aspects of TAAI and to discuss how the key CT imaging findings affect clinical management.

Keywords

Emergency radiology Trauma Aortic injury Abdominal aorta 

Notes

Compliance with ethical standards

Funding

No funding was received for this study.

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

This is a review article and not a study involving procedures on human participants or animals performed by any of the authors.

References

  1. 1.
    Naude GP, Back M, Perry MO, Bongard FS (1997) Blunt disruption of the abdominal aorta: report of a case and review of the literature. J Vasc Surg 25(5):931–935CrossRefPubMedGoogle Scholar
  2. 2.
    Demetriades D, Theodorou D, Murray J, et al. (1996) Mortality and prognostic factors in penetrating injuries of the aorta. J Trauma 40(5):761–763CrossRefPubMedGoogle Scholar
  3. 3.
    Deree J, Shenvi E, Fortlage D, et al. (2007) Patient factors and operating room resuscitation predict mortality in traumatic abdominal aortic injury: A 20 year analysis. J Vasc Surg 45(3):493–497CrossRefPubMedGoogle Scholar
  4. 4.
    Asensio JA, Chahwan S, Hanpeter D, et al. (2000) Operative management and outcome of 302 abdominal vascular injuries. Am J Surg. 180(6):528–534CrossRefPubMedGoogle Scholar
  5. 5.
    Shalhub S, Starnes BW, Tran NT, et al. (2012) Blunt abdominal aortic injury. J Vasc Surg 55(5):1277–1285CrossRefPubMedGoogle Scholar
  6. 6.
    Conrad MF, Crawford RS, Pedraza JD, et al. (2007) Long-term durability of open abdominal aortic aneurysm repair. J Vasc Surg 46(4):669–675CrossRefPubMedGoogle Scholar
  7. 7.
    Lock JS, Huffman AD, Johnson RC (1987) Blunt trauma to the abdominal aorta. J Trauma 27(6):674–677CrossRefPubMedGoogle Scholar
  8. 8.
    Osgood MJ, Heck JM, Rellinger EJ, et al. (2014) Natural history of grade I–II blunt traumatic aortic injury. J Vasc Surg 59:334–342CrossRefPubMedGoogle Scholar
  9. 9.
    Harris DG, Drucker CB, Brenner ML, et al. (2013) Patterns and management of blunt abdominal aortic injury. Ann Vasc Surg 27(8):1074–1080CrossRefPubMedGoogle Scholar
  10. 10.
    Gunn M, Campbell M, Hoffer EK (2007) Traumatic abdominal aortic injury treated by endovascular stent placement. Emerg Radiol 13(6):329–331CrossRefPubMedGoogle Scholar
  11. 11.
    Neschis DG, Scalea TM, Flinn WR, Griffith BP (2008) Blunt aortic injury. N Engl J Med 359:1708–1716CrossRefPubMedGoogle Scholar
  12. 12.
    Feller I, Woodburne RT (1961) RT Surgical anatomy of the abdominal aorta. Ann Surg. 154(6):239–252CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Mellnick VM, McDowell C, Lubner M, Bhalla S, Menias CO (2012) CT features of blunt abdominal aortic injury. Emerg Radiol 19(4):301–307CrossRefPubMedGoogle Scholar
  14. 14.
    Parmley LF, Mattingly TW, Manion WC, Jahnke EJ (1958) Nonpenetrating traumatic injury of the aorta. Circulation 17(6):1086–1101CrossRefPubMedGoogle Scholar
  15. 15.
    Rosengart MR, Zierler RE (2002) Fractured aorta: a case report. Vasc Endovasc Surg 36(6):465–467CrossRefGoogle Scholar
  16. 16.
    Vernhet H, Marty-Ané CH, Lesnik A, et al. (1997) Dissection of the abdominal aorta in blunt trauma: management by percutaneous stent placement. Cardiovasc Intervent Radiol 20(6):473–486CrossRefPubMedGoogle Scholar
  17. 17.
    Salim A, et al. (2006) Whole body imaging in blunt multisystem trauma patients without obvious signs of injury. Arch Surg 141(5):468CrossRefPubMedGoogle Scholar
  18. 18.
    Reisman JD, Morgan AS (1990) Analysis of 46 intra-abdominal aortic injuries from blunt trauma: case reports and literature review. J Trauma 30(10):1294–1297CrossRefPubMedGoogle Scholar
  19. 19.
    de Mestral C, Dueck AD, Gomez D, Haas B, Nathens AB (2012) Associated injuries, management, and outcomes of blunt abdominal aortic injury. J Vasc Surg 56(3):656–660CrossRefPubMedGoogle Scholar
  20. 20.
    Aran S, Daftari Besheli L, Karcaaltincaba M, et al. (2014) Applications of dual-energy CT in emergency radiology. Am J Roentgenol 202(4):W314–W324CrossRefGoogle Scholar
  21. 21.
    Machida H, Tanaka I, Fukui R, et al. (2016) Dual-energy spectral CT: various clinical vascular applications. RadioGraphics 36(4):1215–1232CrossRefPubMedGoogle Scholar
  22. 22.
    McCollough CH, Leng S, Yu L, Fletcher JG (2015) Dual- and multi-energy CT: principles, technical approaches, and clinical applications. Radiology 276(3):637–653CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Vlahos I, Chung R, Nair A, Morgan R (2012) Dual-energy CT: vascular applications. Am J Roentgenol 199:S87–S97CrossRefGoogle Scholar
  24. 24.
    Patino M, Prochowski A, Agrawal MD, et al. (2016) Material separation using dual-energy CT: current and emerging applications. RadioGraphics 36(4):1087–1105CrossRefPubMedGoogle Scholar
  25. 25.
    Johnson TRC (2012) Dual-energy CT: general principles. Am J Roentgenol 199:S3–S8CrossRefGoogle Scholar
  26. 26.
    Aran S, Shaqdan KW, Abujudeh HH (2014) Dual-energy computed tomography (DECT) in emergency radiology: basic principles, techniques, and limitations. Emerg Radiol 21(4):391–405CrossRefPubMedGoogle Scholar
  27. 27.
    Mirvis SE, Shanmuganathan K, Miller BH, White CS, Turney SZ (1996) Traumatic aortic injury: diagnosis with contrast-enhanced thoracic CT–five-year experience at a major trauma center. Radiology 200(2):413–422CrossRefPubMedGoogle Scholar
  28. 28.
    Fabian TC, Davis KA, Gavant ML, et al. (1998) Prospective study of blunt aortic injury: helical CT is diagnostic and antihypertensive therapy reduces rupture. Ann Surg. 227(5):666–767CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Gavant ML, Menke PG, Fabian T, et al. (1995) Blunt traumatic aortic rupture: detection with helical CT of the chest. Radiology 197(1):125–133CrossRefPubMedGoogle Scholar
  30. 30.
    Steenburg SD, Ravenel JG (2008) Acute traumatic thoracic aortic injuries: experience with 64-MDCT. Am J Roentgenol 191(5):1564–1569CrossRefGoogle Scholar
  31. 31.
    Azizzadeh A, Keyhani K, Miller CC, et al. (2009) Blunt traumatic aortic injury: Initial experience with endovascular repair. J Vasc Surg 49(6):1403–1408CrossRefPubMedGoogle Scholar
  32. 32.
    Lee WA, Matsumura JS, Mitchell RS, et al. (2011) Endovascular repair of traumatic thoracic aortic injury: Clinical practice guidelines of the Society for Vascular Surgery. J Vasc Surg 53(1):187–192CrossRefPubMedGoogle Scholar
  33. 33.
    Heneghan RE, Aarabi S, Quiroga E, et al. (2016) Call for a new classification system and treatment strategy in blunt aortic injury. J Vasc Surg 64(1):171–176CrossRefPubMedGoogle Scholar
  34. 34.
    Aladham F, Sundaram B, Williams DM, Quint LE (2010) Traumatic Aortic Injury. J Comput Assist Tomogr 34(3):388–394CrossRefPubMedGoogle Scholar
  35. 35.
    Malhotra AK, Fabian TC, Croce MA, et al. (2001) Minimal aortic injury: a lesion associated with advancing diagnostic techniques. J Trauma 51(6):1042–1048PubMedGoogle Scholar
  36. 36.
    Paul JS, Neideen T, Tutton S, et al. (2011) Minimal aortic injury after blunt trauma: selective nonoperative management is safe. J Trauma Inj Infect Crit Care. 71(6):1519–1523CrossRefGoogle Scholar
  37. 37.
    Caffarelli AD, Mallidi HR, Maggio PM, et al. (2010) Early outcomes of deliberate nonoperative management for blunt thoracic aortic injury in trauma. J Thorac Cardiovasc Surg 140(3):598–605CrossRefPubMedGoogle Scholar
  38. 38.
    Kepros J, Angood P, Jaffe CC, Rabinovici R (2002) Aortic intimal injuries from blunt trauma: resolution profile in nonoperative management. J Trauma 52(3):475–478PubMedGoogle Scholar
  39. 39.
    Forman MJ, Mirvis SE, Hollander DS (2013) Blunt thoracic aortic injuries: CT characterisation and treatment outcomes of minor injury. Eur Radiol 23(11):2988–2995CrossRefPubMedGoogle Scholar
  40. 40.
    Mosquera VX, Marini M, Gulias D, et al. (2012) Minimal traumatic aortic injuries: meaning and natural history. Interact Cardiovasc Thorac Surg 14(6):773–778CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Rivas LA, Múnera F, Fishman JE (2006) Multidetector-row computerized tomography of aortic injury. Semin Roentgenol 41(3):226–236CrossRefPubMedGoogle Scholar
  42. 42.
    Pintar FA, Yoganandan N, Maiman DJ, Scarboro M, Rudd RW (2012) Thoracolumbar spine fractures in frontal impact crashes. Ann Adv Automot Med Assoc Adv Automot Med Annu Sci Conf 56:277–283Google Scholar
  43. 43.
    Richards D, Carhart M, Raasch C, et al. (2006) Incidence of thoracic and lumbar spine injuries for restrained occupants in frontal collisions. Annu Proc Assoc Adv Automot Med 50:125–139PubMedPubMedCentralGoogle Scholar
  44. 44.
    Soto JA, Anderson SW (2012) Multidetector CT of blunt abdominal trauma. Radiology 265(3):678–693CrossRefPubMedGoogle Scholar
  45. 45.
    Chait A, Moltz A, Nelson JH (1968) The collateral arterial circulation in the pelvis. Am J Roentgenol 102(2):392–400CrossRefGoogle Scholar
  46. 46.
    Halkos ME, Nicholas J, Kong LS, Burke JR, Milner R (2006) Endovascular management of blunt abdominal aortic injury. Vascular 14(4):223–226CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Mallinckrodt Institute of RadiologyWashington University in St. LouisSt. LouisUSA

Personalised recommendations