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(Circulation. 1996;94:2865-2870.)
© 1996 American Heart Association, Inc.

Articles

Delayed Surgery of Traumatic Aortic Rupture

Role of Magnetic Resonance Imaging

Rossella Fattori, MD; Francesca Celletti, MD; Paola Bertaccini, MD; Roberto Galli, MD; Davide Pacini, MD; Angelo Pierangeli, MD; Giampaolo Gavelli, MD

the Institute of Radiology and Cardiac Surgery, University Hospital, Bologna, Italy.

Correspondence to Rossella Fattori, MD, Istituto di Radiologia, II Cattedra (Radiologia 3^o), Policlinico S Orsola, Via Massarenti 9, 40138 Bologna, Italy.

Background Traumatic aortic rupture (TAR) is a pathological entity with a high mortality, both spontaneous and perioperative. Delayed surgical repair has been proposed when associated lesions are stabilized. The aim of this study was to validate MRI for detecting both the presence and type of TAR and to monitor posttraumatic aneurysm and associated lesions.

Methods and Results Twenty-four consecutive patients with acute chest trauma and suspected aortic rupture, as suggested by emergency CT or chest radiographs, were subjected to MRI and/or angiography in random order. Such parameters as the presence and type of lesion; presence of periaortic, pericardial, mediastinal, or pleural effusion; and presence of associated lesions were considered in every patient. Follow-up imaging was performed exclusively by MRI every 1 to 2 months. TAR was present in 20 patients. No patient underwent surgery in the acute phase; 14 patients underwent surgery at 6.8±2.7 months; 5 are waiting for surgery; and 1 healed spontaneously. There was no overall mortality. For detection of TAR, the accuracy of MRI was 100%; angiography, 84%; and CT, 69%. In detecting the type of lesion, the diagnostic accuracy of MRI was 92%. During follow-up, a significant increase in the posttraumatic aneurysm was observed in 2 patients, and surgical repair was initiated.

Conclusions In chest trauma patients, MRI provides complete anatomic data to assess the severity of aortic and thoracic lesions. Moreover, along with the concept of delayed surgical repair of TAR, MRI is the ideal modality to monitor and follow TAR before surgical repair.

Key Words: aorta • magnetic resonance imaging • surgery

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