Brian A. Bruckner, MD, Daniel J. DiBardino, MD, Todd C

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Presentation transcript:

Critical Evaluation of Chest Computed Tomography Scans for Blunt Descending Thoracic Aortic Injury Brian A. Bruckner, MD, Daniel J. DiBardino, MD, Todd C. Cumbie, BS, Charles Trinh, MD, Shanda H. Blackmon, MD, Richard G. Fisher, MD, Kenneth L. Mattox, MD, Mathew J. Wall, MD The Annals of Thoracic Surgery Volume 81, Issue 4, Pages 1339-1346 (April 2006) DOI: 10.1016/j.athoracsur.2005.11.012 Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Successive steps in software three-dimensional reconstruction of an aortic injury. A three-dimensional reconstruction of the patient’s thorax is recreated on a computer workstation. Using sophisticated software image subtraction techniques, the surrounding anatomic detail is cleared from the image to reveal the aortic anatomy, and a transection in the descending aorta is seen. The Annals of Thoracic Surgery 2006 81, 1339-1346DOI: (10.1016/j.athoracsur.2005.11.012) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Total number of aortograms performed for blunt chest trauma per year at the Ben Taub General Hospital from years 1997 through 2004. The Annals of Thoracic Surgery 2006 81, 1339-1346DOI: (10.1016/j.athoracsur.2005.11.012) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Total number of aortograms performed for blunt chest trauma per year with percentage undergoing screening computed tomography scan before aortogram (gray bars) from 1997 through 2004. The Annals of Thoracic Surgery 2006 81, 1339-1346DOI: (10.1016/j.athoracsur.2005.11.012) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 (A) Patient A was involved in high-speed motor vehicle accident. The three-dimensional software reconstructions are compared with the aortograms, demonstrating an identical aortic pseudoaneurysm and anatomy. (B) Patient B was also involved in a high-speed motor vehicle accident. Three-dimensional reconstruction images demonstrate a long pseudoaneurysm involving the proximal descending aorta, identical to that seen on the aortogram (middle image). The Annals of Thoracic Surgery 2006 81, 1339-1346DOI: (10.1016/j.athoracsur.2005.11.012) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Problem areas for computed tomographic scanning of blunt aortic injury. (A) Three examples of motion artifact seen in three-dimensional reconstruction of ascending aorta. (B) Two examples of the branch vessels with surrounding structures and artifacts that make identification of injury difficult. The Annals of Thoracic Surgery 2006 81, 1339-1346DOI: (10.1016/j.athoracsur.2005.11.012) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 A practical algorithm for suspected blunt aortic injury. *Obvious chest x-ray signs of aortic injury do not need CT chest at this time (if the surgeon is comfortable). Following other CT scans, the stable patient should proceed to aortogram. **At this time, aortogram should be obtained to confirm injury and delineate the operative anatomy. In the future, as technology improves, the surgeon will probably be able to proceed to operation without aortogram. (Abd = abdominal; CT = computed tomography; 3-D = three-dimensional.) The Annals of Thoracic Surgery 2006 81, 1339-1346DOI: (10.1016/j.athoracsur.2005.11.012) Copyright © 2006 The Society of Thoracic Surgeons Terms and Conditions