title: The role of echocardiography in blunt chest trauma: a transthoracic and transesophageal echocardiographic study.
abstract: Previous studies assessing the value of transthoracic echocardiography (TTE) in blunt chest trauma are limited because patients with severe chest wall injury often have suboptimal echocardiographic findings. Transesophageal echocardiography (TEE) can provide high quality images when the transthoracic image quality is poor. To provide complete echocardiographic assessment of cardiac structure and function we prospectively performed TTE in 105 patients with severe blunt chest trauma and TEE in 20 of the 105 patients (19%) whose TTE examination results were suboptimal. Myocardial contusion was diagnosed in 31 patients (30%), 22 by TTE and nine by TEE. Cardiac complications developed in 8 of 31 patients (26%) with myocardial contusion compared with 2 of 74 patients (3%) with normal echocardiographic findings (p = 0.001). Cardiac complications required treatment in only four patients. Echocardiography was of value in detecting severe right ventricular dysfunction as the cause of hypotension in two patients with suspected cardiac tamponade. Four patients with myocardial contusion died compared with two patients with normal echocardiographic findings (p = NS). No death was related to the cardiac status. In addition, TEE detected aortic injury in five patients, four with focal intimal tears and one with an aortic transection. We conclude that myocardial contusion is common following blunt chest trauma, rarely requires treatment, and is associated with a favorable prognosis. Only patients who develop cardiac complications benefit from echocardiography. Transesophageal echocardiography is of value when the TTE examination results are suboptimal and when aortic injury is suspected.
authors.affiliation: Department of Cardiology, Hahnemann University Hospital, Philadelphia, PA 19102.
authors.forename: D G
authors.initials: DG
authors.lastname: Karalis
authors.forename: M F
authors.initials: MF
authors.lastname: Victor
authors.forename: G A
authors.initials: GA
authors.lastname: Davis
authors.forename: M P
authors.initials: MP
authors.lastname: McAllister
authors.forename: V A
authors.initials: VA
authors.lastname: Covalesky
authors.forename: J J
authors.initials: JJ
authors.lastname: Ross
authors.forename: R V
authors.initials: RV
authors.lastname: Foley
authors.forename: M D
authors.initials: MD
authors.lastname: Kerstein
authors.forename: K
authors.initials: K
authors.lastname: Chandrasekaran
mesh_terms: D015998:Abbreviated Injury Scale; D000293:Adolescent; D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D002648:Child; D003402:Creatine Kinase / Q000097:blood; D017548:Echocardiography, Transesophageal / Q000379:methods*; D005260:Female; D006335:Heart Injuries / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007022:Hypotension / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D015994:Incidence; D007527:Isoenzymes; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013898:Thoracic Injuries / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology
chemical_list: D007527:Isoenzymes; D003402:Creatine Kinase