Traumatic Aortic Injury: Computerized Tomographic Findings at Presentation and After Conservative Therapy

Objective: To determine the computerized tomographic (CT) findings in traumatic aortic injury (TAI) at presentation and after conservative management. Methods: Institutional review board-approved retrospective review of trauma registry during a 6-year period identified class 1 or 2 trauma patients with TAI. The CT findings were correlated with patient outcome. Results: Forty-eight of 3350 patients had TAI. Seven had TAI limited to the abdominal aorta. Twenty-nine of 48 had early (12) or delayed (17) aortic repair. Common abnormalities were pseudoaneurysms (69%) and intramural hematoma (IMH) (65%). Forty-one of 48 TAI were confirmed on endovascular imaging or surgery. Subsequent CT was available in those who had delayed repair (n = 9) or conservative management (10) and showed stable pseudoaneurysms with resolving IMH (n = 11), resolving IMH (n = 4), intimal flap (n = 2), aortic thrombus (n = 1), and dissection (n = 1). Conclusions: Traumatic aortic injury is rare. It commonly involves thoracic aorta with pseudoaneurysm and IMH. Significant TAI in stable patients remains stable on follow-up imaging. Minor TAI may resolve with conservative therapy.