来源：双语学影像；本期病例选自AuntMinnie.com
Our appreciation is extended to Dr. Nimesh Pandey, University of Pennsylvania Department of Radiology, for contributing this case.
History and CT topogram
HistoryA 30-year-old man status post motor vehicle collision.
30岁男性，车祸伤。
CT topogram is shown below.
1.There is mediastinal widening（纵膈增宽）.
True
False
2.There is a right lung contusion（右肺挫伤）.
True
False
3.There is left diaphragmatic rupture（左膈肌破裂）.
True
False
Unenhanced CT
Unenhanced CT images are shown below.
4.Mediastinal hemorrhage（纵膈出血） is present.
True
False
5.Hemorrhagic right pleural effusion（右侧胸腔血性积液） is present.
True
False
6.It is unlikely that the complex material in the mediastium is vascular in origin.
纵膈内的混杂密度不太可能来源于血管
True
False
enhanced CT
Enhanced CT angiography images are shown below.
7.What is the diagnosis?
Acute traumatic aortic injury (ATAI)
Pulmonary arterial rupture
Myocardial aneurysm
Sternal fracture
Esophageal perforation
答案：
True The mediastinum is bilaterally widened at the level of the anteroposterior window.
False The lungs are clear.
False Left diaphragm contour is smooth and normal
True
False There is LEFT hemorrhagic pleural effusion.
False There is obliteration of the fat plane between the aorta and mediastinal hemorrhage, highly concerning for aortic injury.
Acute traumatic aortic injury (ATAI) ATAI is the best possible answer given aortic contour abnormality, mediastinal hematoma, and hemorrhagic effusion.
ATAI/aortic transection
Most commonly due to rapid deceleration event with shearing forces applied at levels of aortic anchoring.
大部分是由于急刹车而对主动脉产生的剪切伤造成。
EpidemiologyPatients who have aortic root tears almost never survive to hospital admission due to severity of the injury and proximity to pericardium and coronary artery ostia.
主动脉根部撕裂多累及心包和冠状动脉开口，创伤非常严重，患者几乎来不及结束治疗就已经死亡。
85% of all patients with ATAI expire before arriving at hospital.
约85%的ATAI患者在送达医院之前就已经死亡。
Cause of 20% of deaths post motor vehicle collision.
约20%的死亡原因为车祸伤
2% long-term survival.
约2%的患者可存活
Imaging Findings
RadiographyWidened mediastinum larger than 8 cm, disruption of left mediastinal/cardiac contours, left "apical cap" opacity due to hemorrhage and effusion, tracheal or nasogastric tube shift
纵膈增宽超过8cm，左侧纵膈/心影连续性中断，出血和渗出导致左侧肺尖帽密度增高，器官或胃管移位。
CTIndirect signs: Mediastinal hematoma, complex pleural effusion
直接征象：纵膈血肿、复杂性胸腔积液
Direct signs: Abnormal aortic contour, intimal flap, active extravasation, sudden caliber change of aorta
间接征象：异常主动脉轮廓、内膜片、血管外渗、主动脉口径突然改变。
MRILimited usage for ATAI; used primarily to detect intramural hematoma and outpatient follow-up of treated ATAI.
MR对ATAI作用有限，主要用于检查壁内血肿，以及ATAI治疗后的随访。
