Transmediastinal gunshot wounds. A reconsideration of the role of aortography.
OBJECTIVE
To evaluate the contribution of aortography in the management of stable patients with transmediastinal gunshot wounds.


METHODS
Retrospective review of clinical records.


METHODS
Level I urban trauma center.


METHODS
Forty-three patients with aortic or esophageal gunshot injuries.


METHODS
Patients who were stable after initial resuscitation underwent aortography followed by esophagography.


METHODS
Hemodynamic status on admission, time devoted to diagnostic workup, surgical (or autopsy) findings, morbidity, and mortality.


RESULTS
There were 24 esophageal injuries and 20 aortic injuries. Patients with aortic injuries were less often stable for aortography (10% vs 42%; P = .02), and fewer of them survived (15% vs 58%; P = .01). In no patient was the aortic injury initially detected by aortography. Stable patients with esophageal injuries experienced an average 11-hour interval between injury and surgery (nearly 3 hours attributable to aortography).


CONCLUSIONS
Esophageal evaluation should precede aortography in the workup of stable patients with transmediastinal gunshot wounds.
Cornwell
E E
EE
Department of Surgery, University of Southern California School of Medicine, USA.
Kennedy
F
F
Ayad
I A
IA
Berne
T V
TV
Velmahos
G
G
Asensio
J
J
Demetriades
D
D
D000293:Adolescent; D000328:Adult; D000368:Aged; D001011:Aorta / Q000293:injuries*; D001027:Aortography; D004947:Esophagus / Q000000981:diagnostic imaging* / Q000293:injuries*; D005260:Female; D006801:Humans; D008297:Male; D008482:Mediastinum / Q000293:injuries*; D008875:Middle Aged; D012189:Retrospective Studies; D014948:Wounds, Gunshot