What is the most accurate method to diagnose traumatic aortic arch injury?

From the Guidelines

The most accurate method to diagnose traumatic aortic arch injury is Chest computed tomography (CT) with contrast (option B). This recommendation is based on the high sensitivity and specificity of CT angiography in diagnosing traumatic aortic injuries, as reported in the 2022 ACC/AHA guideline for the diagnosis and management of aortic disease 1. The guideline states that CT has become the preferred modality for evaluating most patients with suspected aortic disease, including traumatic aortic injury, due to its widespread availability, quick performance, and ability to diagnose the underlying condition and show the full extent of the dissection. Some of the key benefits of CT angiography include:

• High sensitivity (approaching 100%) and specificity (98-100%) for diagnosing traumatic aortic injuries
• Rapid acquisition times, which is crucial for trauma patients who may have multiple injuries requiring prompt diagnosis and management
• Ability to identify intimal tears, pseudoaneurysms, active extravasation, or complete transection
• Allows simultaneous evaluation of other potential thoracic injuries, providing comprehensive assessment in trauma patients In contrast, other imaging modalities such as upright chest x-ray, magnetic resonance imaging, and transesophageal echocardiogram have limitations, including lower sensitivity and specificity, longer acquisition times, and operator-dependent results 1. Therefore, CT angiography is the gold standard for diagnosing traumatic aortic injuries and should be the first-line imaging modality in suspected cases.

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 imaging techniques.

• Upright chest x-ray is not considered the most accurate method for diagnosing traumatic aortic arch injury, as it may not provide detailed images of the aorta.
• Chest computed tomography (CT) is a highly sensitive and specific method for diagnosing traumatic aortic injury, with studies showing it to be the diagnostic test of choice in the acute setting 2, 3, 4, 5.
• Magnetic resonance imaging (MRI) may also be used for diagnosis, but it is not as commonly used in the acute setting as CT.
• Transesophageal echocardiogram (TEE) is an accurate method for diagnosis of traumatic aortic injury, with high sensitivity and specificity, especially for minor injuries 6.

Comparison of Diagnostic Methods

The following points compare the diagnostic methods:

• TEE has a sensitivity of 98% and specificity of 100% for diagnosing traumatic aortic injury, making it a highly accurate method 6.
• CT angiography has a sensitivity of 83-97% and specificity of 100% for diagnosing traumatic aortic injury, depending on the severity of the injury 6, 2, 3, 4, 5.
• The choice of diagnostic method may depend on the clinical presentation and the availability of imaging modalities.

Imaging Findings and Pitfalls

It is essential to be aware of the imaging findings and potential pitfalls when diagnosing traumatic aortic arch injury, including:

• Direct and indirect signs of injury on CT scans 2, 3, 4, 5.
• Grading systems for traumatic aortic injury 3.
• Normal variants and mimics of traumatic aortic injury that may lead to misdiagnosis 4.