(Circulation. 1995;92:2959-2968.)
© 1995 American Heart Association, Inc.
Articles |
Role of Transesophageal Echocardiography in the Diagnosis and Management of Traumatic Aortic Disruption
From the Department of Intensive Care (P.V., H.G.), Department of Cardiology (P.L., O.A., J.B.), and Department of Cardiovascular and Thoracic Surgery (E.C.), Dupuytren Hospital, Limoges, France; Department of Cardiology, Henri Mondor Hospital (P.G.), Créteil, France; Department of Anesthesiology and Intensive Care, Edouard Herriot Hospital (J.M.V.), Lyon, France; and Department of Medicine, Section of Cardiology, University of Chicago Hospitals (R.M.L.), Chicago, Ill.
Correspondence to Philippe Vignon, MD, MC5084, University of Chicago Hospitals, 5841 S Maryland Ave, Chicago, IL 60637.
Background Traumatic disruption of the aorta (TDA) is a life-threatening injury that requires rapid diagnosis and treatment. Emergency aortography, which is the current standard diagnostic imaging modality, is invasive, time-consuming, and difficult to perform in hemodynamically unstable patients with multiple trauma. We performed transesophageal echocardiography (TEE) in patients with suspected TDA to determine the diagnostic accuracy and impact on patient management of this alternative, portable imaging modality.
Methods and Results Thirty-two consecutive trauma patients (mean age, 40±16 years) with suspected TDA (violent deceleration accident and mediastinum >8 cm on admission chest x-ray) prospectively underwent a TEE examination in the emergency room. Findings during TEE were compared with those encountered during aortography, surgery, or necropsy. Two subsets of traumatic aortic injuries with distinct echocardiographic signs were observed: (1) subadventitial TDA (n=10) and (2) traumatic intimal tears (n=3). Eighteen patients had normal TEE confirmed by aortography. One 2-mm medial tear was missed by TEE (necropsy). The sensitivity and specificity of TEE for the diagnosis of subadventitial TDA were 91% and 100%, respectively. Patients with subadventitial TDA were taken to surgery immediately, whereas patients with intimal aortic tears were treated conservatively. Eighteen patients (mean age, 57±15 years) with confirmed acute aortic dissection involving the aortic isthmus were also included to establish the echocardiographic differential diagnostic criteria between this entity and TDA.
Conclusions TEE should be considered the first-line imaging modality for the evaluation of trauma patients with suspected injuries of the thoracic aorta because of its portability, safety, diagnostic accuracy, and potential impact on patient management.
Key Words: echocardiography • aorta • diagnosis • imaging
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