Superior pericardial recess simulating aortic dissection on computed tomography

Computed tomography is frequently used in the initial workup of patients with suspected aortic dissection to distinguish dissection involving the ascending aorta from dissection limited to the descending aorta. We reviewed CT of 19 patients who were proven by aortography to have normal ascending aortas. In eight patients the superior extension of the pericardium was visualized and thought to be a potential source of a false-positive diagnosis of type A aortic dissection.     

特殊类型主动脉夹层的电子束CT表现及诊断

目的探讨表现特殊的主动脉夹层的电子束CT(EBCT)影像特征及诊断.材料和方法20例表现特殊的主动脉夹层,其中不典型夹层13例,三腔以上夹层动脉瘤3例,合并升主动脉壁内血肿的Stanford B型夹层2例,动脉瘤样夹层1例,外伤性主动脉夹层1例.结果主动脉不典型夹层为主动脉壁新月形或环形的低密度血肿包绕,常可见穿透性溃疡或钙化内移等征象;三腔以上夹层动脉瘤有2～3个内膜片,3～4个腔,瘤体管径较大;合并升主动脉壁内血肿的B型夹层见升主动脉管壁低密度新月形或环形增厚,降主动脉则见内膜片及真假两腔形成;动脉瘤样主动脉夹层见降主动脉局限性瘤样扩张,破口大,内膜片不易发现.1例外伤性夹层于主动脉弓峡部及降部起始见破裂内膜片.结论特殊类型的主动脉夹层表现各具特征,EBCT可清晰显示,是极适用于胸部急症的快速、无创的检查方法.     

主动脉夹层及主动脉瘤的外科治疗26例

 目的 结合主动脉夹层细化分型的临床应用,探讨主动脉夹层及主动脉瘤外科手术治疗的临床经验.方法 26例主动脉夹层及主动脉瘤患者,在深低温停循环选择性脑灌注下,行升主动脉加全弓替换4例,全弓替换1例;分段停循环下,行全胸腹主动脉替换术1例;常温阻断加血泵法血液回收股动脉输入法,行降主动脉替换2例,股动脉、股静脉转流降主动脉人工血管替换1例;常规低温体外循环下,行Bentall术6例,Wheat术3例,Bentall加二尖瓣替换1例,Bentall加冠状动脉旁路移植术2例,升主动脉替换1例,升主动脉加部分弓替换1例,主动脉瓣成形加升主动脉替换1例;全麻下带膜支架主动脉腔内修复术2例.结果 本组26例,手术早期死亡1例,病死率3.8%;术后并发严重脑功能障碍2例,昏迷时间分别为15 d,30d,占7.6%.共随访24例,随访率92%,死亡1例.结论 Stanford分型的细化对明确手术指征和确立手术预案具有指导意义.四分支人工血管的应用缩短了主动脉阻断时间,结合选择性脑灌注及分段停循环技术,降低了术后并发症.     

外伤性主动脉夹层的CT诊断(附2例报告)

目的：探讨外伤性主动脉夹层的早期CT表现。方法：回顾性分析在我院漏诊及确诊的外伤性主动脉夹层的CT表现。2例中1例行3次CT平扫,1例行CT平扫和增强扫描。结果：2例均为DeBakeyIU型主动脉夹层,1例3次CT平扫示降主动脉管腔进行性增宽,伴双侧胸腔积液;此例因漏诊,患者于2周后死亡。另1例CT平扫示降主动脉增粗,CT增强扫描明确诊断,主要表现为降主动脉扩张,可见真腔、假腔及内膜线;此例患者行支架植入术后,患者预后良好。结论：对于胸部外伤患者,CT平扫时应注意观察主动脉的直径,如果降主动脉增粗、尤其是进行性增粗时,应考虑主动脉夹层的可能。     

Treatment of chronic aortic dissection by transluminal endovascular stent-graft placement: preliminary results.

PURPOSE: To investigate efficacy of stent-graft repair for the treatment of patients with chronic aortic dissection. MATERIALS AND METHODS: Fifteen patients with chronic aortic dissection were treated with endovascular stent-grafts. Entry tears were located in the descending thoracic aorta in all patients. The mean maximum diameter of the descending thoracic aorta was 47 mm +/- 8. The mean diameter of the true lumen at the same level was 20 mm +/- 5. The mean interval between diagnosis and stent-graft procedure was 32 months +/- 91. Stent-grafts were fabricated from expanded polytetrafluoroethylene and Z-stents. RESULTS: Stent-grafts were placed successfully in all patients. Two stent-grafts were required in one patient. Entry closure and thrombosis of the false lumen of the descending thoracic aorta were also achieved in all patients. No procedure-related complications were observed except for postimplantation syndrome, including fever and leukocytosis. The diameter of the true lumen was significantly increased (mean, 31 mm +/- 6) at the level of the descending thoracic aorta (P <.01) and the diameter of the aorta was significantly decreased (mean, 44 mm +/- 8) at the same level (P <.01). There were no deaths and no instances of aortic rupture during the subsequent average follow-up period of 24 months. Secondary stent-graft procedures were required to treat the abdominal component of dissection during follow-up in one patient. CONCLUSIONS: Stent-graft repair of chronic aortic dissection is a safe and effective method and may be an alternative to surgical graft replacement in selected patients. However, further evaluation is mandatory before this method is widely employed.     

胸主动脉夹层动脉瘤X线、超声心动图诊断

目的:在于提高胸主动脉夹层动脉瘤的X线平片诊断.资料与方法:摄心脏常规片10例,其中4例胸透;超声心动图8例.作者分析了其影像表现,并在心脏后前位片上对胸主动脉各部宽度进行了测量.结果:各部测量其平均值均大于正常,升主动脉与弓降部瘤样扩张8例,降主动脉边缘呈波浪状1例.超声心动图探及主动脉内摆动性内膜与夹层6例,升主动脉内破口3例.结论;普通X线检查对诊断本病有重要意义,超声心动图可确诊.     

Hybrid endograft for one-step treatment of multisegment disease of the thoracic aorta

PURPOSE: At present, a two-step surgical approach is necessary to treat patients with coexistent pathologic conditions involving the proximal and descending thoracic aorta. A hybrid endograft is described here that enables such treatment during a single operation. MATERIALS AND METHODS: The Chavan-Haverich endograft consists of a Dacron vascular prosthesis with stainless-steel stents affixed at its distal end. After approval by the institutional review board, the endograft was prospectively implanted in 22 patients with multisegment thoracic aortic disease (13 men, nine women; median age, 64 years). Eleven patients had type A dissections (one acute, 10 chronic), four had a chronic type B dissection, and seven had atherosclerotic aneurysms of the ascending aorta or aortic arch as well as of the descending aorta. Of these patients, 11 additionally required aortic valve replacement or coronary artery bypass grafting. Via median sternotomy, the aortic arch was opened in circulatory arrest. After antegrade deployment of the stent-containing portion in the descending aorta, the proximal non-stent-containing endograft was used to reconstruct the aortic arch. Median follow-up was 14 months. RESULTS: Endograft implantation was successful in all but one patient. Complications included neurologic deficits that were transient in one case and lasting in two, two cases of vocal cord paralysis, and one death. In all patients with atherosclerotic aneurysms who received the endograft (six of seven), aneurysm thrombosis was noted at follow-up. In aortic dissections, partial or complete false-lumen thrombosis to the level of the stents occurred in all patients. None of the patients showed a progressive widening of the descending aorta. CONCLUSION: The Chavan-Haverich endograft enables one-step treatment of multisegment pathologic conditions affecting the thoracic aorta that otherwise would require two or more operations.     

The use of high-field magnetic resonance in the follow-up of patients with mechanic aortic valve prosthesis and composite aortic tubular prosthesis

Eleven patients who had undergone cardiac surgery were studied by means of high-field MR imaging (1.5 T). Six patients had had aortic root and valve replaced with a Bj?rk-Shiley (BS) composite tubular aortic graft prosthesis for acute dissection of ascending aorta. In the other 5 patients with rheumatic calcific aortic disease, the valve had been replaced with a BS prosthesis. As a whole, MRI studies were 14. Previous evaluations of magnetic field effects had seem carried out ex vivo on both BS valves and BS composite prostheses, on surgical ligation clips (Tantalium and Stainless) and on stainless wires for sternal closure. In 4 patients (2 BS composite grafts and 2 BS valves) MRI diagnosed chronic dissection of both arch and descending aorta. In 1 of them, with a BS valve, associated localized acute dissection of ascending aorta was observed. In 3 patients with BS composite grafts, MRI revealed pseudo-aneurysms (including a thrombosed one) at the graft level. In one case MRI was repeated 4 times and was very helpful in monitoring the pseudo-aneurysm. MRI showed pericardial hematoma in 2 patients with BS grafts and paravalvular abscess in a case with BS valve. In one patient with BS valve fast-imaging MR revealed severe aortic regurgitation. No adverse reactions were demonstrated on MR images of prosthetic implants. MRI artifacts were insignificant with the spin-echo technique, while the fast-imaging technique showed clear image distortion at the valve level.     

Synthetic interposition grafts of the thoracic aorta: postoperative appearance on serial CT studies

PURPOSE: To determine the normal postoperative appearance of thoracic aortic interposition grafts on serial CT studies and to document CT detectable complications. MATERIALS AND METHODS: The 235 CT studies in 114 patients with one or more thoracic aortic interposition grafts were analyzed for the presence or absence of felt rings, felt pledgets, low-attenuation material surrounding the graft, pseudoaneurysm, and dissection flap. A graft was present in the ascending aorta in 93 patients, in the descending aorta in 25, and in the arch in 11. RESULTS: Low-attenuation material was seen adjacent to the ascending graft in 55%-82% of patients and adjacent to the descending graft in 60%-79% of patients, showing diminishing frequency and thickness over time. CT scans in 30 of 53 patients showed residual low-attenuation material adjacent to the graft more than 1 year after surgery. CT scans in four of 93 patients with ascending grafts and one of 25 patients with descending grafts showed a pseudoaneurysm. CONCLUSION: CT studies obtained after aortic interposition grafting show characteristic findings. Knowledge of the type of operative procedure and typical location and CT appearance of surgical materials used is important to correctly diagnose or exclude postoperative complications following thoracic aortic interposition grafting.     

Descending thoracic aortic diseases: stent-graft repair

PURPOSE: To evaluate endovascular treatment of descending thoracic aorta with commercially available self-expanding stent-grafts. MATERIALS AND METHODS: Seventy patients with aortic dissection, intramural hemorrhage, degenerative and posttraumatic aneurysm, penetrating atherosclerotic ulcer, and pseudoaneurysm underwent endovascular treatment. Eleven patients had impending rupture and were treated on an emergency basis. Stent-grafts were customized or selected on the basis of spiral computed tomographic (CT) or magnetic resonance (MR) imaging measurements. Preprocedure diagnostic angiography was performed in patients with aortic dissection and in other selected patients. All procedures were performed in an operating room and monitored with digital subtraction angiography (DSA) and transesophageal echocardiography (TEE). Follow-up was at 1, 3, 6, and 12 months after treatment and yearly thereafter. RESULTS: Stent positioning was technically successful in 68 cases. At DSA and TEE, complete aneurysm or false-lumen exclusion was achieved in 66 (97%) cases. No intraoperative mortality or complications occurred. In-hospital complications included transient monoparesis (one patient) and extension of dissection into ascending aorta (one patient) that was repaired surgically. Early endoleak was observed in five (7%) patients: In three (type 2), endoleak resolved spontaneously; in one (type 1), it was persistent; and in one (type 1), treatment was converted to surgery. At long term, one (1%) patient died of aortic rupture; another, of respiratory insufficiency. Five (7%) late endoleak (type 1, one caused by migration of the stent) cases were observed. In three (4%), endovascular treatment was successful; in two (3%), surgery was performed. In one patient with persistent postimplantation syndrome, treatment was converted to surgery after successful aneurysm sealing. Procedure failure (ie, aortic disease-related mortality or conversion to surgery) occurred in six (9%) patients. CONCLUSION: Endovascular stent-graft repair is less invasive in patients with chronic and acute descending thoracic aortic aneurysm and dissection.     

主动脉不典型夹层的电子束CT诊断

目的 评价电子束CT（EBCT）在主动脉不典型夹层诊断中的临床应用。方法 1994年5月至2000年4月15000例EBCT检查中诊断主动脉夹层263例,其中25例为不典型夹层。男21例,女4例。全部患者均以主诉急性胸痛入院检查。采用Imatron 150-XP型EBCT扫描机,连续容积增强扫描,层厚3mm,扫描时间为0．1s。扫描范围自主动脉弓水平至左右髂动脉分叉处,共140层。结果 不典型夹层EBCT血管造影（EBCTA）：直接征象为:(1)25例主动脉壁均呈半月状或环状增厚,达5－23mm,平均15．3mm,无内膜破裂形成的双腔主动脉征象,CT值50－87HU,累及长度为2．5－49．0cm,平均16．3cm;（2）内膜钙化移位5例;（3）6例治疗后EBCT随访,管壁厚度呈动态变化。间接征象为：（1）主动脉壁增厚溃疡形成7例;（2）动脉粥样硬化性改变12例。上述征象结合临床急性胸痛病史,诊断可以成立。病变累及升主动脉（StanfordA型）6例;仅累及降主动脉（StanfordB型）19例。全部病例临床均采取保守治疗,其中6例EBCT复查,3个月至1年血肿吸收。结论 急诊胸痛鉴别诊断中EBCT对主动脉不典型夹层诊断是一种无创、安全、有效的诊断方法,且便于治疗后随诊观察。     

Aortic growth rates in chronic aortic dissection

AIM: To determine and compare rates of descending aortic enlargement and complications in chronic aortic dissection with and without a proximal aortic graft. METHODS AND MATERIALS: Fifty-two patients with dissection involving the descending aorta and who had undergone at least two computed tomography (CT) examinations at our institution between November, 1993 and February, 2004 were identified, including 24 non-operated patients (four type A, 20 type B) and 28 operated patients (type A). CT examinations per patient ranged from two to 10, and follow-up ranged from 1-123 months (mean 49 months, median 38.5 months). On each CT image, the aortic short axis (SA), false lumen (FL), and true lumen (TL) diameters were measured at the longitudinal midpoint of the dissection and at the point of maximum aortic diameter. Complications were tabulated, including aortic rupture and aortic enlargement requiring surgery. RESULTS: For non-operated patients, the midpoint and maximum point SA, TL, and FL diameters increased significantly over time. For operated patients, the midpoint and maximum point SA and FL diameters increased significantly over time. In both groups, aortic enlargement was predominantly due to FL expansion. Diameter increases in non-operated patients were significantly larger than those in operated patients. The rate of change in aortic diameter was constant, regardless of aortic size. Four non-operated and six operated patients developed aortic complications. CONCLUSIONS: In patients with a dissection involving the descending thoracic aorta, the FL increased in diameter over time, at a constant rate, and to a greater degree in non-operated patients (mostly type B) compared with operated patients (all type A).     

Acute non-opacified dissection of the ascending thoracic aorta--significance of retrograde dissection and re-dissection]

Thirteen cases of acute aortic dissection with non-opacified false lumen of the ascending aorta were examined by CT and other imaging modalities. On the basis of the initial CT findings, these cases were classified into two types; one was pure non-opacified dissection not associated with opacified false lumen (Type N, n = 7), the other was non-opacified dissection of the ascending aorta associated with opacified false lumen of the following aorta (Type N+O, n = 6). On examining the relation between the entry site and the false lumen in Type N+O, the dissection of the ascending aorta was considered to be retrograde. Retrograde dissection seemed to be an important factor in the development of the non-opacified dissection of the ascending aorta. During the follow-up period, re-dissection in the ascending aorta occurred in four of the 13 cases (Type N = 3, Type N+O = 1). The re-dissection occurred within the first four weeks in all of them, and the diagnosis of re-dissection was possible at its early stage. In one case, ulcerlike projection (ULP) was detected by aortography. In another case, ULP was identified by cine-MR imaging. Contrast CT also revealed enlargement and small opacification of the false lumen. In two other cases, similar CT findings were observed. Three of the four patients recovered by surgical treatment. One died the day after the diagnosis of re-dissection. Early diagnosis and earliest possible surgical intervention for re-dissection were considered necessary to save the patients with re-dissected false lumen in the ascending aorta. Close observations with several imaging modalities, mainly CT examination, should be paid in the patients with non-opacified dissection of the ascending aorta for at least four weeks after the onset of dissection.     

85例Stanford B型主动脉夹层腔内修复治疗体会

目的 探讨胸主动脉腔内修复术(TEVAR)治疗Stanford B型主动脉夹层(AD)方法与疗效.方法 回顾性分析2010年1月至2016年4月采用TEVAR治疗的85例Stanford B型AD患者临床资料.85例患者均常规行左肱动脉穿刺,右侧股动脉直切口,升主动脉DSA造影明确AD破口位置、真假腔及与重要器官血管开口位置关系;置入覆膜血管内支架,封堵原发破口,升主动脉造影复查观察近端破口封闭情况及主动脉弓部分支血管、真假腔血流变化情况.结果 84例患者TEVAR手术成功,成功率100％;1例术前麻醉过程中突发AD破裂死亡.9例部分覆盖左锁骨下动脉,1例左锁骨下动脉“烟囱”支架完全封闭左颈总动脉和左锁骨下动脉,2例行无名动脉至左颈总动脉和左锁骨下动脉转流.Ⅰ型内漏2例,无住院期间死亡.术后随访3个月至3年,患者均存活,远端再发新破口2例.结论 TEVAR术治疗Stanford B型AD安全有效,严格把握手术指征、术中精细操作及加强术后院外管理是手术成功、提高远期生存率关键.     

MR evaluation of chronic aortic dissection

Thirty patients with suspected or known chronic aortic dissection were imaged with magnetic resonance (MR), CT, and angiography. Five of these patients had previously undergone surgical repair of the ascending aorta for a type A dissection. Magnetic resonance demonstrated an intimal flap and a double lumen in 25 cases. In four cases with a thrombosed false lumen, proved angiographically, an intimal flap and double channel were not seen. In two of four aortic dissections with a thrombosed false lumen, CT made the diagnosis by showing displaced intimal calcifications not visualized on MR. In one case the aortic dissection was made on CT and angiography but was not supported by MR which showed an aortic aneurysm, subsequently confirmed at surgery. Magnetic resonance, CT, and aortography differentiated between type A (nine patients) or B (20 patients) dissection in all cases and demonstrated extension into the abdominal aorta. Extension into the iliac arteries was seen on MR in three patients but missed in nine patients. Magnetic resonance differentiated the true and false lumen in all but one case. Thrombosis of the false channel was identified in four cases by a decrease in signal intensity on the second echo image. Cardiac gating and longitudinal contiguous sections seemed to be more suitable for appreciation of the relationships with arch vessels. Transverse contiguous slices allowed determination of the origin of celiac, mesenteric, and renal arteries from either the true or the false lumen. This study confirms that MR is an accurate and noninvasive method for the evaluation and follow-up of chronic aortic dissection, obviating the need for iodinated contrast media.     

电子束CT诊断累及升主动脉及主动脉瓣的大动脉炎

目的 探讨电子束CT（EBCT）诊断累及升主动脉 及主动脉瓣的大动脉炎的临床价值。方法 自1996年4月至1999年9月,25例大动脉炎患者接受了EBCT检查。采用美国Imatron公司150－XP型EBCT扫描机,扫描方式：采用增强单层容积扫描（SSM）,扫描层厚3mm,扫描时间0.1s,心电门控;连续容积扫描（CVS）,层厚3mm,扫描时间0.1s.非离子型对比剂,300mgI/ml.其中17例累及升主动脉及主动脉瓣,4例因重度主动脉瓣关闭不全行换瓣手术,病理诊断大动脉炎。2例2年后因瓣周漏再次行换瓣手术。结果 17例均有升主动脉壁不同程度的管理增厚且延续至主动脉瓣水平;活动期10例动脉管壁增厚呈环状高密度影或分层状,内壁光滑。非活动期7例管壁增厚程度轻,呈低密度环。11例升主动脉扩张,左心室扩大,主动脉瓣中－重度关闭不全。4例手术换患者病理所见符合大动脉炎所见。结论 大动脉炎基本CT征象是动脉壁增厚,累及升主动脉者可同时累及主动脉瓣,造成主动脉瓣关闭不全,活动期应为手术禁忌征。EBCT对检出此类大动脉炎有重要价值并且可反映大动脉炎的过程。     

获得性胸主动脉病变的MRI诊断

目的：评价ＭＲＩ对获得性胸主动脉病变的诊断价值。材料和方法：共３０例,２１例在ＧＥＶｅｃｔｒａ０．５Ｔ上行ＳＥ和ＣｉｎｅＭＲＩ检查,９例在ＧＥＳｉｇｎａ１．５Ｔ上行ＳＥ、ＣｉｎｅＭＲＩ、ＧａｔｅｄＴＯＦ和３Ｄ动态增强ＭＲＡ检查。成像采用横断面、主动脉长轴和左室长轴观,部分加扫矢状面和冠状面。结果：共发现升主动脉瘤１０例、主动脉夹层１０例、主动脉扩张９例和降主动脉溃疡１例。经对照表明ＣｉｎｅＭＲＩ对合并的瓣膜病变、夹层真假腔、血栓和瘤内异常血流方式的显示较ＳＥ为佳,而ＧａｔｅｄＴＯＦ和３Ｄ动态增强ＭＲＡ对整个胸主动脉形态及头臂血管的显示最佳。结论：多种ＭＲＩ技术综合运用诊断获得性胸主动脉病变可基本达到心血管造影效果。     

MR imaging of the thoracic aorta in Marfan patients

A characteristic shape of the ascending aorta has been reported in patients with Marfan syndrome. To evaluate the capability of magnetic resonance (MR) imaging to distinguish between marfanoid and other aortic aneurysms, 11 Marfan patients (group 1), eight patients with ascending aorta enlargement (group 2), and 20 normal subjects (group 3) had transverse and sagittal MR of the thoracic aorta. Aortic diameter was measured at the sinuses of Valsalva (SV), the caudal portion of the ascending aorta, the prearch region (PA), the middle arch, and the descending aorta. The ratio SV/PA was significantly greater (p less than 0.001) in group 1 compared with groups 2 and 3. The SV/PA in all Marfan patients exceeded 1.4 but was less than 1.3 in subjects of groups 2 and 3. Magnetic resonance imaging provides definitive measurements of aortic dimensions and is potentially the method of choice for establishing the diagnosis of aortic involvement in Marfan syndrome and monitoring the course of aortic enlargement.     

Diagnostic imaging of aortic diseases

Summary The aim of this overview is the comparison between noninvasive tomographic imaging modalities such as surface echocardiography, transesophageal echocardiography, X-ray computed tomography and magnetic resonance imaging with the previous gold standard angiography in the setting of acute and chronic aortic diseases. Methods: The groundwork for the comparison between various noninvasive modalities is the validation of findings with angiography or intraoperative and histopathological results. Results and conclusions: Noninvasive modalities such as transesophageal echocardiography, X-ray computed tomography and magnetic resonance imaging are suitable methods for reliable diagnosis or exclusion of aortic dissection both in the ascending and descending segment of the thoracic aorta. Other more rare pathologies of the aorta such as intramural hemorrhage as a precursor of dissection, aortic ulcers, aneurysms as well as congenital and posttraumatic lesions may also be subjected to transesophageal echocardiography or magnetic resonance imaging with excellent sensitivity and specificity; both techniques have also proven to be safe procedures in critically ill patients and have, in our view, replaced angiography for the diagnosis of acute aortic syndromes. Thus, in acute aortic diseases invasive angiographic procedures should be relegated to a complementary role, while transesophageal echocardiography, X-ray computed tomography (especially helical CT) in acute, and magnetic resonance imaging in chronic cases represent prefered diagnostic options. In addition to primary diagnostics the noninvasive approaches using transesophageal echocardiography and magnetic resonance imaging are superbly suitable for serial follow-up imaging in all forms of aortic pathology. Eingegangen am 23. Januar 1997 Angenommen am 23. Januar 1997     

Spiral CT aortography: an efficient technique for the diagnosis of traumatic aortic injury

The objective of this study was to assess the efficiency of spiral CT (SCT) aortography for diagnosing acute aortic lesions in blunt thoracic trauma patients. Between October 1992 and June 1997, 487 SCT scans of the chest were performed on blunt thoracic trauma patients. To assess aortic injury, the following SCT criteria were considered: hemomediastinum, peri-aortic hematoma, irregular aspect of the aortic wall, aortic pseudodiverticulum, intimal flap and traumatic dissection. Aortic injury was diagnosed on 14 SCT examinations (2.9 %), five of the patients having had an additional digital aortography that confirmed the aortic trauma. Twelve subjects underwent surgical repair of the thoracic aorta, which in all but one case confirmed the aortic injury. Two patients died before surgery from severe brain lesions. The aortic blunt lesions were confirmed at autopsy. According to the follow-up of the other 473 patients, we are aware of no false-negative SCT examination. Our limited series shows a sensitivity of 100 % and specificity of 99.8 % of SCT aortography in the diagnosis of aortic injury. It is concluded that SCT aortagraphy is an accurate diagnostic method for the assessment of aortic injury in blunt thoracic trauma patients. Received 18 July 1997; Revision received 11 September 1997; Accepted 23 October 1997