In Reply to: Case 0298_09 --Non-operative Management of Traumatic Aortic Injury posted by Editor on February 03, 1998 at 11:52:55:
Fascinating case. I have a few comments:
1) The negative CT is one of the first such cases I've seen. I have a problem with making too much about this case because it was still not in my opinion, a scan which is state of the art meaning thin (3-5mm), contiguous spiral images. In my experience, there is a big difference in edge resolution in aortic lesions between 5 and 10 mm sections--so maybe this lesion would have been seen.
2) Several centers are using IVUS to look at these injuries and manage them conservatively. According to Pam Flick in Memphis, IVUS really shows a lot more intimal injury on these patients, occasionally showing reasonably impressive abnormalities even with negative or minimally positive angios.
3) We produce much worse looking lesions after angioplasty and we used to congratulate ourselves for doing such a "nice" job. Another analogy: has anyone seen an angio of a carotid artery post-endarterectomy? Hoo boy; no wonder they stopped getting them!!
My point is of course, that we may be approaching a sort of radiologic Uncertainty Principle in which our ability to make informed decisions becomes poorer and poorer as our ability to measure things becomes better and better.
Bottom line for me is that I think that intimal damage without disruption is going to prove to be like the analogies I made above--leave 'em alone.
By the way, Al Nemcek agrees with me and therefore won't spew forth his usual erudition.