Evaluation of transesophageal echocardiography for diagnosis of traumatic aortic injury.
BACKGROUND
Traumatic aortic injury is a frequent cause of death after blunt trauma, but few patients survive to reach a trauma center. The role of transesophageal echocardiography (TEE) in the diagnosis of traumatic aortic injury remains debated.


METHODS
Over a 9-yr period, 209 blunt trauma patients (mean age, 34 +/- 13 yr) were suspected of having traumatic aortic injury because of enlarged mediastinum and/or sudden deceleration, and underwent TEE and angiography (aortography and/or contrast-enhanced computed tomography.


RESULTS
Traumatic aortic injury was diagnosed in 42 patients (20%). Angiography (aortography and/or contrast-enhanced computed tomography) was less accurate (sensitivity, 83%; specificity, 100%) than TEE (sensitivity, 98%; specificity, 100%) for the diagnosis of aortic injury because it failed to diagnose most minor injuries (intramural hematoma or limited intimal flap, n = 7). However, when considering only patients with major aortic injury (n = 33; i.e., those who might need surgery), angiography (sensitivity, 97%; specificity, 100%) and TEE (sensitivity, 97%; specificity, 100%) were equivalent.


CONCLUSIONS
Transesophageal echocardiography is an accurate method for diagnosis of traumatic aortic injury. Nevertheless, the clinical implications of limited aortic injuries diagnosed by the technique have yet to be determined.
Goarin
J P
JP
Department of Anesthesiology and Critical Care, Centre Hospitalier Universitaire Pitié-Salpêtrière, Université Pierre et Marie Curie, Paris, France.
Cluzel
P
P
Gosgnach
M
M
Lamine
K
K
Coriat
P
P
Riou
B
B
D000058:Accidental Falls; D000063:Accidents, Traffic; D000328:Adult; D017677:Age Distribution; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000293:injuries*; D001027:Aortography; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D008297:Male; D008482:Mediastinum / Q000000981:diagnostic imaging; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*