Penetrating aerodigestive injuries in the neck: a proposed CT-aided modified selective management algorithm.
OBJECTIVE
To determine the specific CT findings of penetrating neck wound profile predicting aerodigestive injuries, diagnostic performance of CTA and to propose a modified selective management algorithm to reduce nontherapeutic invasive procedures.


METHODS
We retrospectively evaluated CTAs of 102 patients to determine the presence of various CT signs. "Trajectory"-based signs included trajectory of the wound extending into the aerodigestive tract and trajectory violating the deep neck spaces. "Conventional" signs included transcervical injury; wall defect; air or blood in the deep neck spaces; irregular or thickened aerodigestive tract; and active mucosal bleeding.


RESULTS
Trajectory of the wound extending into the aerodigestive tract (sensitivity 76 %, specificity 97 %) and trajectory of the wound violating the suprahyoid deep neck spaces or the infrahyoid visceral space (sensitivity 97 %, specificity 55 %) were the best predictors of injury on regression analysis. The most specific "conventional" CT signs were "wall defect" and "active mucosal bleed", but had very low sensitivity. The sensitivity of CTA for detecting an injury ranged from 89.5 % to 92 %, specificity ranged from 62.5 % to 89 %.


CONCLUSIONS
CTA can be a useful technique in detecting aerodigestive injury. Our proposed management algorithm can exclude an injury with high degree of confidence (sensitivity 97 %).


CONCLUSIONS
• Trajectory-based CT signs predict aerodigestive injury after penetrating neck trauma. • Surgery should be considered when trajectory extends into the infra-arytenoid aerodigestive tract. • Endoscopy or exploration should be considered when trajectory violates deep neck spaces. • This modified approach can decrease negative explorations and invasive diagnostic procedures.
R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22S Greene Street, Baltimore, MD, USA. ubodanapally@umm.edu.|Department of Radiology, University of Maryland Medical Center, 22S Greene Street, Baltimore, MD, USA. ubodanapally@umm.edu.
Uttam K
UK
Bodanapally
R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22S Greene Street, Baltimore, MD, USA.|Department of Radiology, University of Maryland Medical Center, 22S Greene Street, Baltimore, MD, USA.
Kathirkamanathan
K
Shanmuganathan
R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22S Greene Street, Baltimore, MD, USA.|Department of Radiology, University of Maryland Medical Center, 22S Greene Street, Baltimore, MD, USA.
David
D
Dreizin
R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22S Greene Street, Baltimore, MD, USA.|Department of Surgery, University of Maryland Medical Center, 22S Greene Street, Baltimore, MD, USA.
Deborah
D
Stein
University of Iowa Carver College of Medicine, Iowa City, IA, USA.
Amit K
AK
Reddy
R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22S Greene Street, Baltimore, MD, USA.|Department of Radiology, University of Maryland Medical Center, 22S Greene Street, Baltimore, MD, USA.
Stuart E
SE
Mirvis
R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22S Greene Street, Baltimore, MD, USA.|Departement of Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA.
Matthew
M
Vasquez
R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22S Greene Street, Baltimore, MD, USA.|Departement of Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA.
Cassandra
C
Cardarelli
R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22S Greene Street, Baltimore, MD, USA.|Department of Otorhinolaryngology-Head & Neck Surgery, University of Maryland Medical Center, 22S Greene Street, Baltimore, MD, USA.
Elizabeth
E
Guardiani
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000072226:Computed Tomography Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000000981:diagnostic imaging; D019838:Neck Injuries / Q000000981:diagnostic imaging*; D015203:Reproducibility of Results; D012137:Respiratory System / Q000000981:diagnostic imaging* / Q000293:injuries*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014950:Wounds, Penetrating / Q000000981:diagnostic imaging*; D055815:Young Adult
Imaging; Multidetector-row computed tomography; Neck injuries; Oesophageal perforation; Wounds, penetrating