Rapid diagnosis of thoracic aortic transection using intravenous digital subtraction angiography*

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Rupture of the thoracic aorta associated with blunt trauma remains a frequently lethal injury. Although increasing numbers of patients with ruptured aortas are surviving to reach the hospital, the in-hospital mortality attending this injury remains high. Death due to transected aorta has been related to a delay in diagnosis. In an attempt to decrease the time necessary for diagnosis of this injury, we studied 50 patients using intravenous digital subtraction angiography (IVDSA) and conventional biplane angiography. We found that IVDSA was significantly faster than conventional biplane angiography, and that when IVDSA films are of diagnostic quality, they are sufficient to reliably demonstrate the presence of traumatic aortic transection. Our study was too small to establish whether IVDSA is a sufficiently sensitive test to exclude aortic injury. Further studies in this area need to be performed.

References (25)

  • BrooksAP et al.

    Computerized tomography in the diagnosis of traumatic rupture of the thoracic aorta

    Clin Radiol

    (1989)
  • FeldmanL

    Digital subtraction angiography of the chest

    Clin Chest Med

    (1984)
  • ParmleyLF et al.

    Nonpenetrating traumatic injury of the thoracic aorta

    Circulation

    (1958)
  • GreendylkeRM

    Traumatic rupture of the aorta: Special reference to automobile accidents

    JAMA

    (1966)
  • SvenssonLG et al.

    Traumatic rupture of the thoracic aorta

    S Afr Med J

    (1985)
  • FisherRG et al.

    Laceration of the thoracic aorta and brachiocephalic arteries by blunt trauma

    Radiol Clin North Am

    (1981)
  • Eddy AC, Rusch VW, Fligner CL, et al. The epidemiology of traumatic rupture of the aorta in the pediatric patient: a...
  • StarkP

    Traumatic rupture of the thoracic aorta: A review

    CRC Crit Rev Diagn Imaging

    (1984)
  • CollicottPE et al.
  • HoodRM et al.

    Thoracic trauma

  • SymbasPN et al.

    Traumatic rupture of the aorta

    Ann Surg

    (1973)
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    *

    Presented at the 76th Annual Meeting of the North Pacific Surgical Association, Victoria, British Columbia, Canada, November 10–11, 1989.

    1

    From the Division of Cardiothoracic Surgery, Department of Surgery, Harborview Medical Center, Seattle, Washington.

    2

    From the Division of Trauma, Department of Surgery, Harborview Medical Center, Seattle, Washington.

    3

    the Division of Interventional Radiology, Department of Radiology, Harborview Medical Center and the University of Washington, Seattle, Washington.

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