Harry B. Kram, M. D. , David A. Wohlmuth, M. D. , Paul L. Appel, M. P

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Presentation transcript:

Clinical and radiographic indications for aortography in blunt chest trauma Harry B. Kram, M.D., David A. Wohlmuth, M.D., Paul L. Appel, M.P.A., William C. Shoemaker, M.D. Journal of Vascular Surgery Volume 6, Issue 2, Pages 168-176 (August 1987) DOI: 10.1067/mva.1987.avs0060168 Copyright © 1987 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 1 Mediastinal widths, as measured on initial chest radiography, in patients with suspected thoracic aortic rupture. Bars represent mean ± SD. Group I patients had normal mediastinal widths (less than 8 cm) and no aortic injuries (N = 7), group II patients had mediastinal widening and no aortic injuries (N = 47), and group III patients had mediastinal widening and thoracic aortic rupture (N = 10). Note that although both group II and III patients had significantly greater mediastinal widths than patients in group I (p < 0.05 by analysis of variance [ANOVA]), there was no significant difference in mediastinal widths between patients in group II vs. group III. Journal of Vascular Surgery 1987 6, 168-176DOI: (10.1067/mva.1987.avs0060168) Copyright © 1987 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 2 A, Admission chest radiograph of a 36-year-old man after a high-speed automobile accident. Note mediastinal widening (10.1 cm), deviation of the nasogastric tube to the right (large arrow), deviation of the central venous pressure line to the right (small arrow), deviation of the trachea to the right (asterisk), blurring of the aortic knob, opacification of the aortopulmonary space, and left hemothorax. B, Aortogram obtained from patient shown in A. A left chest tube has been placed. Note aortic injury located at the level of the left subclavian artery. Journal of Vascular Surgery 1987 6, 168-176DOI: (10.1067/mva.1987.avs0060168) Copyright © 1987 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 3 A, Admission chest radiograph of a 44-year-old woman after a high-speed automobile accident. Note mediastinal widening (12.0 cm), deviation of the nasogastric tube to the right (large arrow), widened paratracheal stripe (small arrow), deviation of the trachea to the right (asterisk), blurring of the aortic knob, opacification of the aortopulmonary space, abnormal paraspinous stripe, and bilateral hemothoraces. B, Aortogram obtained from patient shown in A. Note aortic injury located near level of the ligamentum arteriosum; the intraluminal filling defect of the descending aorta proved to represent a large blood clot. Journal of Vascular Surgery 1987 6, 168-176DOI: (10.1067/mva.1987.avs0060168) Copyright © 1987 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 4 A, Admission chest radiograph of a 20-year-old man after an automobile accident. Note that in this patient, mediastinal widening (10.6 cm) and blurring of the aortic knob were the only radiographic signs of thoracic aortic rupture that were present. Physical signs and symptoms diagnostic of thoracic aortic rupture were also absent. B, Aortogram obtained from patient shown in A. Note aortic injury located at level of the left subclavian artery. Journal of Vascular Surgery 1987 6, 168-176DOI: (10.1067/mva.1987.avs0060168) Copyright © 1987 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions

Fig. 5 Algorithm for the diagnosis of traumatic thoracic aortic rupture. Entrance criteria include all patients with severe or high velocity/deceleration blunt chest trauma. Journal of Vascular Surgery 1987 6, 168-176DOI: (10.1067/mva.1987.avs0060168) Copyright © 1987 Society for Vascular Surgery and North American Chapter, International Society for Cardiovascular Surgery Terms and Conditions