Can Chest CT be Used to Exclude Aortic Injury?

Can Chest CT be Used to Exclude Aortic Injury?


Debra S. Dyer, MD ; Ernest E. Moore, MD ; Michael F. Mestek, MD ; Steven M. Bernstein, MD ; Dave N. Iklé, PhD ; Janette D. Durham, MD ; Marsha J. Heinig, MD ; Paul D. Russ, MD ; David L. Symonds, MD ; David A. Kumpe, MD ; Edward J. Roe, MD ; Benjamin Honigman, MD ; Robert C. McIntyre, Jr, MD ; John Eule, Jr, MD

1 From the Depts of Radiology (D.S.D., S.M.B., J.D.D., P.D.R., D.A.K.) and Surgery (R.C.M.), Div of Emergency Medicine (B.H.), University of Colorado Health Sciences Center, Box A030, 4200 E 9th Ave, Denver, CO 80262; Depts of Surgery (E.E.M.) and Radiology (M.F.M., M.J.H., D.L.S., J.E.), Div of Emergency Medicine (E.J.R.), Denver Health Medical Center, Colo; and Dept of Biostatistics, National Jewish Medical and Research Center, Denver (D.N.I.). Received Jul 20, 1998; revision requested Aug 28; revision received Dec 14; accepted Mar 26, 1999. Supported in part by a grant from the Society for Thoracic Radiology Research and Education Fund.

PURPOSE: To determine whether chest computed tomography (CT) can be used to exclude aortic injury.

MATERIALS AND METHODS: Patients in whom there was very high suspicion of traumatic aortic injury were examined with aortography only. Other patients were examined with contrast material–enhanced CT. Follow-up aortography was performed in all patients with moderate to high suspicion of traumatic aortic injury and in all patients with CT scans that were positive for traumatic aortic injury. CT scans were regarded as positive when they showed mediastinal hematoma or direct findings of aortic injury. During a 4½-year period, 1,009 patients (263 female, 746 male; age range, 3–90 years) were evaluated for possible traumatic aortic injury.

RESULTS: Of the 207 patients who underwent aortography directly without CT, 10 had traumatic aortic injury. Of the 802 patients who were examined with CT, 382 underwent follow-up aortography. In this group, there were 10 true-positive and no false-negative CT scans. CT had 100% sensitivity and a 100% negative predictive value for the detection of traumatic aortic injury.

CONCLUSION: Chest CT can be used to exclude aortic injury.