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Park H, Shin TG, Kim WY, Jo YH, Hwang YJ, Choi SH, Lim TH, Hna KS, Shin J, Suh GJ, Kang GH, Kim KS, Korean Shock Society investigators. Current updates in acute traumatic aortic injury: radiologic diagnosis and management. Clin Exp Emerg Med 2022; 9:73-83. [PMID: 35843607 PMCID: PMC9288877 DOI: 10.15441/ceem.22.233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Accepted: 02/23/2022] [Indexed: 12/04/2022] Open
Abstract
Acute traumatic aortic injuries, which have substantial lethal outcomes at the time of admission, are fatal in 80% to 90% of cases. These injuries are relatively rare and have nonspecific clinical presentations. Radiologists and emergency physicians need to identify the radiological signs of acute traumatic aortic injury and differentiate them from common imaging errors to ensure accurate diagnosis and determine appropriate management protocols. In combination with image-guided interventions, advances in cross-sectional imaging have enabled nonsurgical management of acute traumatic aortic injuries. Timely and precise diagnoses of these injuries following prompt treatment are essential as up to 90% of patients presenting at the hospital can undergo early repair.
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Esmat HA, Naseri MW. Traumatic aortic transection in a teenager presenting with hemorrhagic shock. INTERNATIONAL JOURNAL OF SURGERY OPEN 2021. [DOI: 10.1016/j.ijso.2021.100325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Chang SW, Choi KK, Kim OH, Kim M, Lee GJ. Part 4. Clinical Practice Guideline for Surveillance and Imaging Studies of Trauma Patients in the Trauma Bay from the Korean Society of Traumatology. JOURNAL OF TRAUMA AND INJURY 2020. [DOI: 10.20408/jti.2020.0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Identification of aortic injury site using postmortem non-contrast computed tomography in road traffic accident. Radiol Case Rep 2020; 16:5-8. [PMID: 33144902 PMCID: PMC7596009 DOI: 10.1016/j.radcr.2020.10.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/14/2020] [Accepted: 10/17/2020] [Indexed: 11/23/2022] Open
Abstract
In high-speed motor vehicle accidents, it is necessary to investigate the manner of death. Postmortem computed tomography (PMCT) provides important information on the mechanism of death, but identification of the aortic injury is still challenging on non-contrast PMCT. A man in his 50s had multiple injuries on the face and chest in the high-speed motor vehicle accident. The traumatic aortic rupture was clearly depicted on thin-slice and multiplanar reformation PMCT images. Traumatic aortic disruption was confirmed by forensic autopsy. The high contrast between the aortic wall and the lumen visualized the traumatic rupture in the distal aortic arch. For the evaluation of aortic rupture on PMCT, it may be important to trace the continuity of the high-density aortic wall by reviewing thin-slice CT and multiplanar reformation images.
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Dziekiewicz M, Laska G, Makowski K. Undersized Stentgraft Placement for Traumatic Descending Aorta Rupture, and What Is Next? AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e926299. [PMID: 32728016 PMCID: PMC7417028 DOI: 10.12659/ajcr.926299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/20/2020] [Accepted: 06/24/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Traumatic injury of the thoracic aorta is proving to be not only the most lethal of traumatic injuries, but also the most urgent reason for vascular intervention among all trauma patients. Endovascular aortic repair is used increasingly often to treat traumatic injuries. We report a case of endovascular treatment and its use as a delayed correction (two-stage treatment) for a traumatic aortic isthmus rupture. CASE REPORT A 20-year-old Asian male was admitted to our department after a car accident presenting symptoms of ischemic shock. Among multiple injuries, a traumatic descending aorta rupture was diagnosed. The patient was referred directly to the operating room for a thoracic endovascular aortic repair (TEVAR). The patient's other trauma-related injuries required additional interventions in the following days. Thirty days after the emergent TEVAR operation, the patient required reintervention due to a major type-I endoleak. Computed tomography angiography revealed a failed stentgraft deployment. We removed the mismatched endovascular equipment and deployed an appropriately sized stentgraft during a hybrid procedure, excluding the ruptured aortic wall altogether. CONCLUSIONS Endovascular treatment of both children and small-framed adults remains a challenge for operating teams. First, no dedicated equipment can be found on the market. Second, measuring and fitting endovascular equipment constitutes a sore point in treatment, so in emergency situations, only off-the-shelf tools are accessible. We assert that, in such cases, the primary procedure should be understood as a lifesaving intervention, awaiting a final and long-lasting solution.
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Affiliation(s)
- Mirosław Dziekiewicz
- Department of Vascular and Endovascular Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Grażyna Laska
- Department of Vascular and Endovascular Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Karol Makowski
- Department of Military Health Service, Ministry of Defense, Warsaw, Poland
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Shyu JY, Khurana B, Soto JA, Biffl WL, Camacho MA, Diercks DB, Glanc P, Kalva SP, Khosa F, Meyer BJ, Ptak T, Raja AS, Salim A, West OC, Lockhart ME. ACR Appropriateness Criteria® Major Blunt Trauma. J Am Coll Radiol 2020; 17:S160-S174. [PMID: 32370960 DOI: 10.1016/j.jacr.2020.01.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 01/22/2020] [Indexed: 11/20/2022]
Abstract
This review assesses the appropriateness of various imaging studies for adult major blunt trauma or polytrauma in the acute setting. Trauma is the leading cause of mortality for people in the United States <45 years of age, and the fourth leading cause of death overall. Imaging, in particular CT, plays a critical role in the management of these patients, and a number of indications are discussed in this publication, including patients who are hemodynamically stable or unstable; patients with additional injuries to the face, extremities, chest, bowel, or urinary system; and pregnant patients. Excluded from consideration in this review are penetrating traumatic injuries, burns, and injuries to pediatric patients. Patients with suspected injury to the head and spine are also discussed more specifically in other appropriateness criteria documents. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Jeffrey Y Shyu
- Research Author, Brigham & Women's Hospital, Boston, Massachusetts
| | - Bharti Khurana
- Principal Author, Brigham & Women's Hospital, Boston, Massachusetts.
| | - Jorge A Soto
- Research Author, Boston University School of Medicine, Boston, Massachusetts
| | - Walter L Biffl
- Scripps Memorial Hospital La Jolla, La Jolla, California; American Association for the Surgery of Trauma
| | - Marc A Camacho
- The University of South Florida Morsani College of Medicine, Tampa, Florida
| | - Deborah B Diercks
- University of Texas Southwestern Medical Center, Dallas, Texas; American College of Emergency Physicians
| | - Phyllis Glanc
- University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Faisal Khosa
- Vancouver General Hospital, Vancouver, British Columbia, Canada
| | | | - Thomas Ptak
- University of Maryland Medical Center, Baltimore, Maryland
| | - Ali S Raja
- Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Society for Academic Emergency Medicine
| | - Ali Salim
- Brigham & Women's Hospital, Boston, Massachusetts; American College of Surgeons
| | - O Clark West
- UTHealth McGovern Medical School, Houston, Texas
| | - Mark E Lockhart
- Specialty Chair, University of Alabama at Birmingham, Birmingham, Alabama
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REICHARDT GABRIELSEBBEN, NOGUEIRA GABRIELMONDIN, RAFAEL LEONARDOKRIEGER, SOLTOSKI PAULOROBERTO, PIMENTEL SILVANIAKLUG. CT scanning in blunt chest trauma: validation of decision instruments. Rev Col Bras Cir 2020; 47:e20202648. [DOI: 10.1590/0100-6991e-20202648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/27/2020] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to perform an external validation of two clinical decision instruments (DIs) - Chest CT-All and Chest CT-Major - in a cohort of patients with blunt chest trauma undergoing chest CT scanning at a trauma referral center, and determine if these DIs are safe options for selective ordering of chest CT scans in patients with blunt chest trauma admitted to emergency units. Methods: cross-sectional study of patients with blunt chest trauma undergoing chest CT scanning over a period of 11 months. Chest CT reports were cross-checked with the patients’ electronic medical record data. The sensitivity and specificity of both instruments were calculated. Results: the study included 764 patients. The Chest CT-All DI showed 100% sensitivity for all injuries and specificity values of 33.6% for injuries of major clinical significance and 40.4% for any lesion. The Chest CT-Major DI had sensitivity of 100% for injuries of major clinical significance, which decreased to 98.6% for any lesions, and specificity values of 37.4% for injuries of major clinical significance and 44.6% for all lesions. Conclusion: both clinical DIs validated in this study showed adequate sensitivity to detect chest injuries on CT and can be safely used to forego chest CT evaluation in patients without any of the criteria that define each DI. Had the Chest CT-All and Chest CT-Major DIs been applied in this cohort, the number of CT scans performed would have decreased by 23.1% and 24.6%, respectively, resulting in cost reduction and avoiding unnecessary radiation exposure.
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Wangdi S, LeVine S, Watts M. Arrow to the Chest. Clin Pract Cases Emerg Med 2019; 3:327-328. [PMID: 31763579 PMCID: PMC6861027 DOI: 10.5811/cpcem.2019.9.43991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/13/2019] [Accepted: 09/09/2019] [Indexed: 11/29/2022] Open
Abstract
A 33-year-old male was brought to the emergency department after a penetrating arrow injury to the chest. Initial evaluation revealed the arrow was penetrating the sternum, lung, and aortic arch. Because the patient was in a remote area, timely transfer to a specialized center for definitive operative repair was delayed approximately 24 hours. Treatment was focused on minimizing risk of hemorrhage with tight blood pressure control, while tube thoracostomy was deferred to avoid a change in intrathoracic pressure. The left-sided hemothorax was monitored with serial point-of-care ultrasounds. Ultimately he was successfully transferred and underwent successful surgical intervention.
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Affiliation(s)
- Sherab Wangdi
- Khesar Gyalpo University of Medical Sciences of Bhutan, Department of Emergency Medicine,Thimphu, Bhutan
| | - Shankar LeVine
- Jigme Dorji Wangchuck National Referral Hospital, Department of Emergency Medicine,Thimphu, Bhutan
| | - Melanie Watts
- Jigme Dorji Wangchuck National Referral Hospital, Department of Emergency Medicine,Thimphu, Bhutan
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MDCT angiography before and after thoracic endovascular aortic repair (TEVAR) in patients with thoracic traumatic aortic injuries. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2018. [DOI: 10.1016/j.ejrnm.2017.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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Pasteur-Rousseau A, Dridi L, Fitoussi A, Peric AS, Dautry R, Dohan A, Bonnin P, Soyer P. Unusual late discovery of interrupted aortic arch by ultrasonography and three-dimensional MDCT. Diagn Interv Imaging 2016; 97:1197-1199. [DOI: 10.1016/j.diii.2016.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 02/07/2016] [Indexed: 12/22/2022]
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Vascular emergencies: Diagnosis and treatment. Diagn Interv Imaging 2015; 96:655-6. [DOI: 10.1016/j.diii.2015.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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