From the Guidelines
The most accurate method to diagnose traumatic aortic arch injury is option B, Chest computed tomography (CT). CT angiography with intravenous contrast is the preferred initial diagnostic test for suspected traumatic aortic injury due to its high sensitivity and specificity, as reported in the 2022 ACC/AHA guideline for the diagnosis and management of aortic disease 1. This imaging modality provides detailed visualization of the aortic anatomy, can identify intimal tears, pseudoaneurysms, active extravasation, and complete transections.
Key Benefits of CT
- CT is widely available in trauma centers, can be performed quickly, and allows simultaneous evaluation of other potential injuries in trauma patients.
- It can detect the presence and mechanism of aortic branch vessel involvement as well as vessel patency, signs of malperfusion, pericardial effusion and hemopericardium, periaortic or mediastinal hematoma, and pleural effusion, as noted in the 2022 ACC/AHA guideline 1.
- The use of electrocardiographic-synchronized CT techniques can accurately depict mediastinal structures, such as the proximal aorta and coronary ostia.
Comparison with Other Imaging Modalities
- While transesophageal echocardiogram (TEE) is also accurate, it is more operator-dependent and invasive.
- Magnetic resonance imaging, though sensitive, is impractical in acute trauma settings due to longer acquisition times and incompatibility with life support equipment.
- Upright chest x-ray may show suggestive findings like widened mediastinum but lacks the sensitivity and specificity needed for definitive diagnosis of aortic injuries.
- The 2014 ESC guidelines on the diagnosis and treatment of aortic diseases also support the use of CT as the preferred initial imaging modality for suspected aortic dissection or traumatic aortic injury, citing its excellent diagnostic accuracy 1.
From the Research
Diagnostic Methods for Traumatic Aortic Arch Injury
The most accurate method to diagnose traumatic aortic arch injury can be determined by evaluating the sensitivity and specificity of various diagnostic tools.
- Upright chest x-ray: This method has been found to have a low sensitivity of 41% for detecting blunt thoracic aortic injury 2.
- Chest computed tomography: Chest CT has been shown to have a high sensitivity and specificity for diagnosing traumatic aortic injury, with a negative predictive value of 100% 3, 4.
- Magnetic resonance imaging: There is no direct evidence provided to support the use of MRI for diagnosing traumatic aortic arch injury.
- Transesophageal echocardiogram: Transesophageal echocardiography has been found to be an accurate method for diagnosing traumatic aortic injury, with a sensitivity of 98% and specificity of 100% 5.
Comparison of Diagnostic Methods
When comparing the diagnostic methods, chest computed tomography and transesophageal echocardiogram appear to be the most accurate methods for diagnosing traumatic aortic arch injury.