Abstract
A retrospective review was undertaken to determine the incidence of, and radiologic findings associated with aortic rupture resulting from blunt chest trauma in children. Records and imaging data of 54 consecutive pediatric patients admitted over a 2 year period to a pediatric trauma center after sustaining blunt chest trauma were reviewed. Four of 54 (7.4%) had a documented aortic tear. Plain films were evaluated for 7 radiographic signs described in the adult literature as sensitive indicators of aortic rupture, including abnormal aortic contour and mediastinal widening. Two groups of patients were defined: Group 1 (n=4) had aortic rupture confirmed by angiography or operation and Group 2 (n=50) with no angiographic investigation. All patients in Group 1 demonstrated mediastinal widening and abnormal aortic contour; however, 50 percent of patients in Group 2 had similar findings. Computed tomograms of the thorax where obtained were reviewed, including 1 patient from Group 1 and 6 patients from Group 2. The aortic tear was well demonstrated in the one patient from Group 1; however, the remaining computed tomograms were deemed inadequate for reliable exclusion of significant aortic injury. Plain chest radiographic findings in 5 consecutive children who underwent aortography in the two years subsequent to this series, including 2 additional patients with aortic rupture, were also reviewed, with similar results. In conclusion, traumatic aortic rupture in the pediatric population may be more common than previously reported. Plain film findings of aortic rupture in children are similar to those in adults, and are sensitive but non-specific. Currently, at least in our institution, this injury may be underinvestigated. Angiography remains the modality of choice in the diagnosis of aortic tears in children.
Similar content being viewed by others
References
Smyth BT (1979) Chest trauma in children. J Paediatr Surg 14:41
Kilman JW, Charnock E (1969) Thoracic trauma in infancy and childhood. J Trauma 9:863
Meller JL, Little AG, Shermata DW (1984) Thoracic trauma in infants. Paediatrics 74:813
Haller JA Jr, Shermeta DW (1975) Major thoracic trauma in children. Pediatr Clin North Am 22:341
Bender TM, Oh KS, Medina JL, Girdany BR (1987) Paediatric chest trauma. J Thorac Imag 2:60
Haller JA (1986) Thoracic Injuries. In: Welch KJ, Randolph JG, Ravitch MM, O'Neill JA, Rowe MI (eds) Paediatric surgery, vol. 1, 4th edn. Year Book Medical Publishers, Chicago, p 143
Felman (1987) Radiology of the paediatric chest. Williams and Wilkins, Baltimore, p 368
Swischuck LE (1979) Emergency radiology of the acutely ill or injured child. Williams and Wilkins, Baltimore, p 111
Kirks DR (1984) Practical paediatric imaging, Little, Brown, Boston Toronto, p 518
Seltzer SE, D'Orsi C, Kirchner R, De Weese JA (1981) Traumatic aortic rupture: plain radiographic findings. AJR 137:1011
Barcia TC, Livoni JP (1983) Indications for angiography in blunt thoracic trauma. Radiology 147:15
Sefczek DM, Sefczek RJ, Deeb ZL (1983) Radiographic signs of acute traumatic rupture of the thoracic aorta. AJR 141:1259
Marnocha KE, Maglinte DD (1985) Plain film criteria for excluding aortic rupture in blunt chest trauma. AJR 144:19
Marsh DG, Sturm JT (1976) Traumatic aortic rupture: roentgenographic indications for angiography. Ann Thorac Surg 21:337
15.Mirvis SE, Bidwell JK, Buddemeyer EU, Diaconis JN, Pais SO, Whitley JE, Goldstein LD (1987) Value of chest radiography in excluding traumatic aortic rupture. Radiology 163:487
Rao PS, Najjar HN, Mardini MK, Solymar L, Thapar MK (1988) Balloon angioplasty for coarctation of the aorta: immediate and long term results. Am Heart J 115:657
Heiberg E, Wolverson MK, Sundaram M, Shields JB (1983) CT in aortic trauma AJR 140:1119
Mirvis SE, Kostrubiak I, Whitley NO, Goldstein LD, Rodriguez A (1987) Role of CT in excluding blunt thoracic trauma. AJR 149:601
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Spouge, A.R., Burrows, P.E., Armstrong, D. et al. Traumatic aortic rupture in the pediatric population. Pediatr Radiol 21, 324–328 (1991). https://doi.org/10.1007/BF02011477
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02011477