Diagnosis of Cardiac Injuries by Surgeon-Performed Ultrasound: a Safe and Expeditious Alternative for Suspected Cardiac Injuries

Abstract

Surgeon-performed ultrasound continues to evolve as a useful, safe, and efficient diagnostic alternative to document the presence of hemopericardium in patients sustaining penetrating injuries to the precordial region. With growing experience, its excellent sensitivity and specificity in the identification of cardiac injuries have become evident. As ultrasound for blunt abdominal trauma has been able to eliminate unnecessary diagnostic peritoneal lavages, its use in the evaluation of penetrating precordial injuries holds the promise to expedite the diagnosis of cardiac injuries and eliminate unnecessary pericardial windows and their associated morbidity.Ultrasound was performed by surgeons-in-training with supervision by a trauma surgeon at a Level-I trauma center in patients sustaining penetrating injuries to the precordial area.During the review period, 34 patients underwent precordial ultrasound (22 negative, 9 positive and 3 equivocal). There were no false-positives or false-negatives. All equivocal results were followed by a subxiphoid pericardial window that demonstrated no evidence of cardiac injury.Based on these data, we recommend that surgeonperformed ultrasound replace all other clinical, radiologic, and surgical diagnostic alternatives classically used to determine the presence of hemopericardium in stable patients with penetrating precordial injuries. Ultrasonography is fast, reliable, consistent, and easy to teach and learn. In those few patients with equivocal findings, other confirmatory diagnostic modalities should be entertained.

The fate and growth of general surgery in the United States

“…Few surgeons have been willing to seek extra training in the specifics of this imaging technique, and of course, they have not been welcomed by "our colleagues" in diagnostic radiology. Contrary to stated opinion, the unwillingness of the radiologist to be up in the middle of the night has ceded trauma ultrasound largely to the practicing trauma general surgeon [4,5,6,7], while ultrasound of the breast [8] and vascular disease remain very contentious. We need more surgeons to celebrate their skills in ultrasonography and commit to providing education for the next generation.…”