CTICasesBlunt Traumatic Aortic Injury with Multifocal Thoracic and Abdominal Involvement
Imaging findings
An adult involved in a high-speed motor vehicle crash had CT showing a small filling defect (intimal tear) at the aortic isthmus with an adjacent smaller defect, plus another small intimal injury in the mid-thoracic aorta behind the left atrium. More caudally there was hematoma adjacent to the diaphragmatic crus, an intramural hematoma extending into the abdominal aorta, and mesenteric fat stranding/hematoma, indicating a multifocal thoracic and abdominal aortic injury from blunt trauma.
Key takeaways
Blunt traumatic aortic injury can be subtle and multifocal, involving small filling defects at the classic isthmic location as well as less common sites such as the mid-thoracic aorta and even extending into the abdominal aorta as intramural hematoma, and these small lesions are easily overlooked; per current vascular surgery society guidance, small lesions under 10 millimeters can be managed conservatively with optional short-interval follow-up imaging, larger lesions warrant elective repair, and any true pseudoaneurysm or active leak should be treated promptly.
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