findings, CT scan of the chest may be considered in patients with severe
thoracoabdominal trauma who are unable to communicate, are unconscious, or
require mechanical ventilation. Hemodynamically instability is a contraindication
to CT scan and warrants prompt resuscitation and intervention.
Hemodynamically stable patients with penetrating thoracic trauma
should undergo CT scan of the chest because of the high risk of internal
damage to mediastinal structures. Missile penetration injury in particular may
result in multiple organ injuries. A contrasted CT scan of the chest can also
characterize the trajectory of the penetrating agent and efficiently inventory
intrathoracic injuries to guide endoscopic interventions or operative
management.
E. Angiography
Catheter-directed angiography has traditionally been the gold standard
for evaluating thoracic aortic injury. However, this study has now largely been
replaced by thoracic CT angiography. Not only does thoracic CT have a high
negative predictive value for vascular injuries, but it is also non-invasive and
provides immediate high resolution images of the chest and intrathoracic
structures. An angiographic examination is considered in rare cases where CT
scan results are equivocal and suspicion for aortic injury remains high.
The use of angiography for endovascular stent repair of the thoracic
aorta is described in the adult literature. However, limited knowledge is
available regarding the safety and efficacy of thoracic endovascular aortic