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Minimal aortic injury

Minimal aortic injuries are traumatic aortic lesions that are limited to the aortic intima and are recognized more frequently due to the use of high-resolution imaging in trauma.

Minimal aortic injuries account for 10-28% of all blunt traumatic aortic injuries 1,6,7. The proportion of this type of aortic injury among overall blunt traumatic aortic injuries is higher in more recent studies due to the widespread use of multidetector computed tomography (MDCT) in trauma.   

Minimal aortic injuries are on the low end of the spectrum of blunt traumatic aortic injury.  Various definitions of minimal aortic injury have been used in literature. They were originally defined as small (<10 mm) intimal flaps with no or minimal periaortic hematoma. Some authors have further defined the injuries as post-traumatic abnormalities of the inner aortic wall projecting into the lumen with no evidence of an abnormality to the outer contour of the aorta.

Like other blunt traumatic aortic injuries, the proposed mechanisms include:

  • rapid deceleration
  • shearing forces
  • osseous pinch
  • sudden increase in hydrostatic forces or water-hammer phenomenon

Injuries limited to the intima usually do not compromise the resistance of the aortic wall and may heal spontaneously by endothelialization.

Most minimal aortic injuries occur in the descending thoracic aorta where other more significant aortic injuries occur, particularly the proximal portion at the aortic isthmus

CT angiography is the investigation of choice. With improvements in imaging technology, which allow a thinner CT slice thickness, minimal aortic injuries are being diagnosed more frequently.

Minimal aortic injuries can present with:

  • intimal irregularity or flap
    • most common imaging appearance (~80%) 1
    • rounded, triangular or focal thin membrane-like filling defects
  • intraluminal aortic thrombus
  • intramural hematoma (~10%) 1

Since intimal injuries may resolve spontaneously, minimal aortic injuries are amenable to non-operative or medical management and can be treated conservatively with anti-hypertensives, anticoagulants or both depending on the coexisting injuries. Limited data on the natural history of this type of aortic injury necessitates close imaging surveillance for detection of any potential complication or adverse evolution of the minimal aortic injury. In some institutions, endovascular repair is another option for treatment.

Normal anatomic variants and conditions that can mimic minimal aortic injuries on CT include:

Article information

rID: 55840
Synonyms or Alternate Spellings:
  • Minimal aortic injuries
  • Minimal injury of the aorta
  • Minimal injuries of the aorta
  • Minimal aortic injury (MAI)
  • Minimal aortic injuries (MAIs)
  • MAI
  • MAIs
  • MAI's

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