Cardiac Trauma

Question 1

CT Signs of Traumatic Aortic Injury

Common signs

Answer 1

• Aortic pseudoaneurysm
• Periaortic hemorrhage
• Displacement of the trachea and esophagus to the right by hematoma, an irregular shape to the aortic lumen
• Intimal flaps projecting into the lumen

Question 2

CT Signs of Traumatic Aortic Injury

Uncommon signs

Answer 2

• Luminal clot at sites of intimal disruption
• Sudden change in caliber of the aorta without intervening branch vessels (coarctation)
• A small aortic caliber in the lower chest and abdomen
• Peridiaphragmatic hemorrhage (from proximal intraluminal thrombus)

Question 3

CT Signs of Traumatic Aortic Injury

Rare signs

Answer 3

• Transection of the aorta
• Active bleeding from the aorta into the mediastinum

Question 4

Mediastinal Clues

Radiographic Findings Suggestive of a Great Vessel Injury

Answer 4

• Obliteration of the aortic knob contour
• Widening of the mediastinum
• Depression of the left mainstem bronchus >140 degrees from trachea
• Loss of paravertebral pleural stripe
• Calcium layering at aortic knob
• Abnormal general appearance of mediastinum
• Deviation of nasogastric tube to the right at T4
• Lateral displacement of the trachea

Question 5

The anatomic “cardiac box” is the area of the chest bound by the

Answer 5

sternal notch superiorly,
xiphoid process inferiorly, and the
nipples laterally.