Delayed surgery of traumatic aortic rupture : Role of magnetic resonance imaging

• Published in: Circulation (New York, N.Y.) Vol. 94; no. 11; pp. 2865 - 2870
• Main Authors: FATTORI, R, CELLETTI, F, BERTACCINI, P, GALLI, R, PACINI, D, PIERANGELI, A, GAVELLI, G
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01-12-1996; American Heart Association, Inc
• Subjects: Adolescent; Adult; Aged; Angiography; Aortic Rupture - diagnosis; Aortic Rupture - diagnostic imaging; Aortic Rupture - surgery; Biological and medical sciences; Female; Follow-Up Studies; Humans; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Time Factors; Tomography, X-Ray Computed; Traumas. Diseases due to physical agents; Treatment Outcome; Vascular injuries: limbs, aorta, vena cava; Human; Late; Cardiovascular disease; Exploration; Nuclear magnetic resonance imaging; Trauma; Vascular disease; Treatment; Surgery; Tissue rupture; Medical imagery; Aorta; Complication; Aortic disease
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.CIR.94.11.2865

Traumatic aortic rupture (TAR) is a pathological entity with a high mortality, both spontaneous and perioperative. Delayed surgical repair has been proposed when associated lesions are stabilized. The aim of this study was to validate MRI for detecting both the presence and type of TAR and to monitor posttraumatic aneurysm and associated lesions.
Twenty-four consecutive patients with acute chest trauma and suspected aortic rupture, as suggested by emergency CT or chest radiographs, were subjected to MRI and/or angiography in random order. Such parameters as the presence and type of lesion; presence of periaortic, pericardial, mediastinal, or pleural effusion; and presence of associated lesions were considered in every patient. Follow-up imaging was performed exclusively by MRI every 1 to 2 months. TAR was present in 20 patients. No patient underwent surgery in the acute phase; 14 patients underwent surgery at 6.8 +/- 2.7 months; 5 are waiting for surgery; and 1 healed spontaneously. There was no overall mortality. For detection of TAR, the accuracy of MRI was 100%; angiography, 84%; and CT, 69%. In detecting the type of lesion, the diagnostic accuracy of MRI was 92%. During follow-up, a significant increase in the posttraumatic aneurysm was observed in 2 patients, and surgical repair was initiated.
In chest trauma patients, MRI provides complete anatomic data to assess the severity of aortic and thoracic lesions. Moreover, along with the concept of delayed surgical repair of TAR, MRI is the ideal modality to monitor and follow TAR before surgical repair.