Traumatic aortic injuries in children: radiologic evaluation

OBJECTIVE: The purpose of this study was to evaluate the radiographic findings in children with traumatic aortic injuries and discuss the imaging techniques currently available for diagnosis.

MATERIALS AND METHODS: A retrospective review of 10,886 children examined because of blunt trauma from 1987 to April 1996 identified seven patients (0.064%) who sustained traumatic aortic injuries. The mechanism of injury, location of aortic injury, additional injuries suffered, trauma scores, sequences of radiologic evaluation, imaging findings, treatment, and outcome were recorded for each child.

RESULTS: Six children had pathologically proven aortic ruptures, and the remaining child had an intimal injury diagnosed with contrast-enhanced helical CT and confirmed with transesophageal echocardiography. All seven children were victims of motor vehicle accidents (six passengers, one pedestrian), all had injuries of the aortic isthmus, and all had additional severe injuries. The mean trauma score, injury severity score, and probability of survival were 14, 39, and 75%, respectively. Imaging techniques included chest radiography (n = 7), conventional CT (n = 1), helical CT (n = 3), aortography (n = 2), and transesophageal echocardiography (n = 3). The initial outcomes included death (n = 1), paraplegia (n = 1), paraparesis (n = 2), and recovery without morbidity (n = 3).

CONCLUSION: Traumatic aortic injuries are rare in children. The most common findings on plain films are a left apical cap, pulmonary contusion, aortic obscuration, and mediastinal widening. Helical CT and transesophageal echocardiography can be used in the diagnosis of traumatic aortic injuries in children.