8.2.5

COMPUTED TOMOGRAPHY OF THORACIC AORTA TRAUMA IN PATIENTS WITH SEVERE COMBINED BLUNT INJURIES

Popova I.E.1, Vladimirova E.S.1, Kokov L.S.1,2, Sharifullin F.A.1,2, Muslimov R.Sh.1, Tarabrin E.A.1

Purpose. To identify the possibilities of computed tomography in detection of the nature and severity of the thoracic aorta trauma. Materials and method. Results of computed tomography (CT) of 15 patients from 2006 to 2017 with severe combined blunt injuries and thoracic aorta injury who had been treated in N. V. Sklifosovsky Research Institute for Emergency Medicine were analyzed. The majority of the patients were male 73% (n=11), the average age was 41,3+ 7,6 (22-79) years. The cause of injury in 12 cases were motor vehicle accidents, in 2 cases – falling from a height of more than three meters, in one case - a fall from patient’s own height. Results. In evaluating the severity of the aortic injuries the classification proposed by the American Association of Thoracic Surgeons in 2013 was used. In our study there were no patients with Grade I; Grade II – small pseudoaneurysm (less than 50% of the circumference of the aorta) was identified in 8 patients; Grade III – big pseudoaneurysm (more than 50% of the circumference of the aorta) was identified in 3 pa-tients; Grade IV – complete aortic rupture was identified in 4 patients. Simultaneously with the thoracic aortic injury pulmonary contusion was found in 9 pa-tients, in 8 - multiple fractured ribs, in 1 – fracture of the sternum. In 8 patients mediastinal hematoma was identified, hemopericardium was found in 3 patients. Hemothorax was found in 12 patients. Signs of craniocerebral trauma were found in 6 patients, spinal cord injury – in 3 patients, injuries of the musculoskeletal system – in 4 patients, abdominal parenchymal organ injury was found in 4 patients (in 3 of these cases - of the liver, in 1 – of the kidney), in one case sings of the duodenal rupture were found, in another – left-sided diaphragmatic rupture, in 1 patient with thoracic aortic rupture, a pseudoaneurysm of the hepatic artery was also found. Discussion. Using the classification of the severity of the aortic injuries by the CT results in patients with stable hemodynamics enables the ability to determine the degree of aortic stability, to predict the risk of rupture and to choose the type of optimal surgical in-tervention (early or delayed). There is a possibility to perform endoprosthetic repair of the aorta and surgical inter-vention of other areas against the background of controlled hypotension in patients with simultaneous traumatic aortic injury and other combined injuries. Conclusion. It is advisable to perform a CT examination at once of several anatomi-cal regions when examining patients with severe combined injuries. Evaluation of the mediastinum structures in patients with severe combined injuries should be performed on the basis of a computed tomography of the chest with mandatory intrave-nous administration of contrast media. It is necessary to perform multiplanar and three-dimensional volume rendering to allow better visualization of the extent of thoracic aortic injuries. Choosing a method of treatment in victims with thoracic aorta injury is based on the use of endoprosthetics as an effective and low-traumatic intervention that can be used sim-ultaneously with other surgical methods of treatment.

1 - N. V. Sklifosovsky Research Institute for Emergency Medicine of Moscow. 2 - I.M. Sechenov First Moscow State Medical University (Sechenov University). Moscow, Russia.


 

Keywords: combined blunt injury, blunt thoracic aortic injury, computed tomography.

 

Corresponding author:: Popova I.E., e-mail: Этот e-mail адрес защищен от спам-ботов, для его просмотра у Вас должен быть включен Javascript

 

For citation: Popova I.E., Vladimirova E.S., Kokov L.S., Sharifullin F.A., Muslimov R.Sh., Tarabrin E.A. Computed tomography of thoracic aorta trauma in patients with severe com-bined blunt injuries. REJR 2018; 8(2):49-57. DOI:10.21569/2222-7415-2018-8-2-49-57.

Received: 12.03.2018 Accepted: 08.04.2018