Ait Ali Yahia D, Bouvier A, Nedelcu C, Urdulashvili M, Thouveny F, Ridereau C, Tanguy J Y, Picquet J, Aube C, Willoteaux S
University of Nantes/Angers/Le Mans (UNAM), Angers, France; Department of Radiology, CHU d'Angers, Angers, France.
University of Nantes/Angers/Le Mans (UNAM), Angers, France; Department of Radiology, CHU d'Angers, Angers, France.
Diagn Interv Imaging. 2015 Jan;96(1):79-88. doi: 10.1016/j.diii.2014.02.003. Epub 2014 Dec 22.
Isthmic aortic rupture or disruption should be systematically sought when there is high kinetic energy trauma to the thorax. This condition is extremely serious and life threatening. It needs to be diagnosed rapidly but diagnostic pitfalls must be avoided. CT angiography is the standard examination. The main CT signs of rupture or disruption of the thoracic aorta are periaortic hematoma, intimal flap, pseudo-aneurysm and contrast agent extravasation. There are three types of lesion: intimal, subadventitial or pseudo-aneurysmal, and complete rupture with lesion of the three tunicae, and it is important to grade them for better therapeutic management. The main diagnostic pitfalls of the CT scan are the presence of a ductus diverticulum and post-isthmic fusiform dilatation. Associated lesions must not be overlooked. The most common are ruptures of the aortic root and the thoracic aorta in the diaphragmatic hiatus.
当胸部遭受高动能创伤时，应系统地排查峡部主动脉破裂或断裂情况。这种情况极其严重，会危及生命。需要迅速做出诊断，但必须避免诊断陷阱。CT血管造影是标准检查方法。胸主动脉破裂或断裂的主要CT征象包括主动脉周围血肿、内膜瓣、假性动脉瘤和造影剂外渗。病变有三种类型：内膜型、外膜下型或假性动脉瘤型，以及三层膜均受累的完全破裂型，对其进行分级对于更好的治疗管理很重要。CT扫描的主要诊断陷阱是动脉导管憩室的存在以及峡部后梭形扩张。相关病变不可忽视。最常见的是主动脉根部破裂和膈裂孔处胸主动脉破裂。
