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Previous Volume 332:356-362 February 9, 1995 Number 6 Next

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ABSTRACT

Background Rupture of the aorta is a major cause of death after motor vehicle accidents. Survival depends on early diagnosis, and emergency aortography is the standard imaging method. Although transesophageal echocardiography is noninvasive and can provide high-resolution images of the aorta, information about its value in patients with trauma is limited. We conducted this study to assess prospectively the value of transesophageal echocardiography in the emergency evaluation of patients at risk for aortic injury.

Methods Transesophageal echocardiography of the aorta was attempted in 101 patients admitted to the emergency room with a diagnosis of possible traumatic rupture of the aorta. Echocardiography and aortography personnel were notified simultaneously of the arrival of the patient, and the two tests were performed sequentially by operators who were blinded to the results of the other test. The sensitivity and specificity of transesophageal echocardiography were calculated on the basis of the results of aortography of the arch, surgery, or autopsy.

Results Transesophageal echocardiography was attempted in 101 patients. The study was successfully performed in 93 patients but could not be completed in 8 because of lack of cooperation on the part of the patient (7 patients) or maxillofacial trauma (1 patient). Despite a high injury-severity score (mean, 29.6), transesophageal echocardiography was performed without complications, and within a mean (±SD) of 29±12 minutes. Eleven of the 93 studies (12 percent) demonstrated rupture of the aorta near the isthmus. The findings were confirmed in 10 of the 11 patients by aortography (9 patients), surgery (9 patients), or autopsy (1 patient), yielding a sensitivity of 100 percent and specificity of 98 percent for the detection of injury to the aorta. There was one false positive echocardiogram.

Conclusions Transesophageal echocardiography is a highly sensitive and specific method of detecting injury to the thoracic aorta. This technique can be used safely and quickly in critically injured patients with suspected traumatic rupture of the aorta and compares favorably with arch aortography.

Source Information

From the Division of Cardiovascular Medicine, Department of Internal Medicine (M.D.S., J.M.C., S.S., E.J.M., P.M.S.), and the Section of Trauma and Critical Care, Department of Surgery (S.B.J., P.A.K.), University of Kentucky and Veterans Affairs Medical Center, Lexington.

Address reprint requests to Dr. Smith at the Division of Cardiology, University of Kentucky Medical Center, Rm. MN670, 800 Rose St., Lexington, KY 40536-0084.

Full Text of this Article

Related Letters:

Notice of Redundant Publication: Transesophageal Echocardiography in the Diagnosis of Traumatic Rupture of the Aorta
Young R.J., Joynt G.M., Gomersall C.D., Smith D. C., Bansal R. C., Azevedo J. E. R., Smith M. D., Kearney P. A.
Extract | Full Text  
N Engl J Med 1995; 333:457-458, Aug 17, 1995. Correspondence

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