Pediatric Thoracic Aortic Injury

  • Etiology: blunt thoracic trauma
  • CXR: wide superior mediastinum, abnormal aortic contour, deviated endotracheal tube or nasogastric tube to right, depression of left mainstem bronchus, left pleural/apical cap, left pneumothorax / pleural effusion, rib fracture
  • CT: 90% at aortic isthmus, periaortic hematoma, intimal flap, pseudoaneurysm, extravasation of contrast
  • Note: mediastinal / chest ratio > 0.25 on CXR should be investigated with CT
  • DDX: patent ductus arteriosus
  • Clinical: uncommon in children

Radiology Cases of Thoracic Aortic Injury

CXR and CT and angiogram of thoracic aortic injury
CXR AP shows widened mediastinum. Axial CT with contrast of the chest shows dilated caliber of the thoracic aorta at the level of the diaphragm with surrounding mediastinal fluid (above) and normal caliber of the abdominal aorta with evidence of retrocrual hemorrhage tracking into the abdomen (below). Angiogram shows a pseudoaneurysm of the aorta at the level of the diaphragm.