RESUMO
The purpose of this retrospective study was to determine the value of contrast-enhanced spiral CT for detecting and managing acute thoracic aortic injury. Trauma registry data and medical records were reviewed for the last 100 patients who were suspected to have traumatic aortic injuries and who underwent contrast enhanced spiral CT. The following CT findings were considered indicative of aortic injury, intimal flap, lumen abnormality, contour irregularity, pseudo-aneurysm, and extravasation of contrast material. On the basis of these direct findings no further investigations were performed. Isolated mediastinal hematoma on CT scans was considered as indirect sign of aortic injury; thoracic aotography was performed for these patients. CT scan was normal in 23 patients and abnormal in 77 patients. Isolated mediastinal hematoma was present in 54 patients. All of them had negative angiograms. The remaining 23 patients had direct CT signs. Aortic injuries were confirmed at the thoracotomy in 21 of them. Successful aortic repair was done in 19 of them, while the remaining 2 patients died from exsanguinations at surgery. On the basis of our results we determined the correct values of sensitivity [92%], specificity [100%], positive predictive value [100%], negative predictive value [99.8%], and accuracy [99.8%]. Contrast enhanced spiral CT has a critical rule in the exclusion of thoracic aortic injuries in patients with major blunt chest trauma and prevents unnecessary thoracic aortography. Direct CT signs of aortic injury don't require further investigations to confirm diagnosis. In cases of isolated mediastinal hematorna other possible sources of bleeding should be considered before directing patients to thoracic aortography. Survival of patients with acute thoracic aortic injuries depends on early surgical repair and this requires prompt and accurate diagnosis