Use of Transesophageal Echocardiography for Diagnosis of Traumatic Aortic Injury

Goarin, Jean Pierre; Catoire, P.; Jacquens, Y.; Saada, M.; Riou, Bruno; Bonnet, Francis; Coriat, Pierre

doi:10.1378/chest.112.1.71

Cited by 61 publications

(20 citation statements)

References 24 publications

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“…32 The presence of a significant mediastinal hematoma, identified as an increased distance from the transducer to the anterior aortic wall or from the posterior aortic wall to the left visceral pleura, 33 , 34 is also considered a marker for possible aortic injury even when direct findings are not demonstrated, 35 ( Fig. 12.9).…”

Section: Great Vessels Traumamentioning

confidence: 99%

Echocardiography in Special Situations

Chenzbraun

2008

Emergency Echocardiography

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This chapter covers complex clinical situations such as chest trauma and more focused issues including transesophageal echocardiography (TEE)-guided cardioversion, suspected stuck prosthetic valve, pacemaker optimization in decompensated cardiac failure, and mechanical support. A subsection is dedicated to the less frequent but challenging cases of acute nonischemic left ventricular systolic dysfunction, such as myocarditis or stressrelated cardiomyopathies which are of special relevance to the ICU environment. The indications and input of echocardiography in the management of these challenging clinical scenarios are presented using a practical approach which makes this chapter useful to anyone directly involved in the management of critically ill patients. ECHOCARDIOGRAPHY IN ACUTE NONISCHEMICLV DYSFUNCTION Coronary artery disease is the most commonly encountered etiology for the occurrence of acute LV systolic failure in clinical practice. However, not infrequently, episodes of severe acute ventricular failure are triggered by nonischemic events. This chapter specifically covers acute nonischemic conditions with documented systolic dysfunction and not cardiac failure clinical syndromes related to diastolic dysfunction, valvular heart disease, or arrhythmias. Echocardiography is crucial for proper evaluation and management in all these entities.

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Section: Great Vessels Traumamentioning

confidence: 99%

Echocardiography in Special Situations

Chenzbraun

2008

Emergency Echocardiography

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“…The mediastinal hematoma may be responsible for an increased distance (over 3 mm) between the esophageal probe and the descending thoracic aorta, as well as for an ultrasound signal between the aortic wall and visceral pleura. A double contour of the aortic wall features the presence of an intramural or peri-aortic hematoma [43,44,45].…”

Section: Other Imaging Modalitiesmentioning

confidence: 99%

“…It does not delay other diagnostic and therapeutic procedures, such as mechanical ventilation or laparotomy, since it can be realized simultaneously [43,45,46]. However, TEE is inappropriate in cases of massive facial trauma, unstable cervical spine fractures, possible injury to the brachiocephalic arteries, combative behavior, acute or chronic esophageal disease, severe coagulopathy, or history of previous radiation therapy in the chest.…”

Section: Other Imaging Modalitiesmentioning

confidence: 99%

“…However, TEE is inappropriate in cases of massive facial trauma, unstable cervical spine fractures, possible injury to the brachiocephalic arteries, combative behavior, acute or chronic esophageal disease, severe coagulopathy, or history of previous radiation therapy in the chest. Nevertheless, its rate of complications, such as aspiration or esophageal perforation, is low [42,45].…”

Section: Other Imaging Modalitiesmentioning

confidence: 99%

“…Pitfalls include strong reflections with distal acoustic shadowing, which represent aortic calcifications, as well as hypoechoic regions within an atheroma that may represent either hemorrhage or fatty deposit [43,44,45].…”

Section: Other Imaging Modalitiesmentioning

confidence: 99%

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Imaging of acute traumatic injuries of the thoracic aorta

2001

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Epidemiology and biomechanicsBlunt injuries of the thoracic aorta are met in 0.5±2 % of chest trauma patients admitted in emergency rooms alive [1,2]. Aortic lesions represent the most lethal condition among chest injuries and are responsible for up to 40 % of fatalities occurring in traffic accidents [2,3]. Head-on and lateral motor vehicle accidents at speeds superior to 50 km/h, or associated with substantial car deformity, are the main cause (76 %) of blunt traumatic aortic injuries, followed by falls from heights ± usually exceeding 3 m ± and crush injuries [4,5,6,7].Four mechanisms are hypothesized to explain blunt lesions to the thoracic aorta [8,9]. Sudden antero-posterior or lateral deceleration superior to 80 g induces anterior cardiac displacement, leading to shearing forces, and sometimes rupture, at the aortic isthmic level [3,8]. Rapid vertical deceleration occurring in falls from height results in aortic arch compression against the anterior thoracic cage. Aortic injuries with such biomechanics are thus located on the ascending aorta [10]. The ªwater-hammer effectº relates to a low thoracic or abdominal compression. The resultant sudden increase of the intra-aortic pressure may be responsible for ascending aortic injuries immediately above the aortic valve. A pressure peak of 80±350 kPa (600±2500 mmHg) is required to rupture a normal aorta [5]. Finally, the ªos-seous pinchº hypothesis assumes a compression of the heart and the aorta between the sternum and vertebral column, for instance, under a violent frontal impact against the steering wheel. The resultant left posterior displacement of the heart generates an aortic torsion, which may result in a traumatic aortic lesion, sometimes associated with thoracic vertebral fractures [11]. Eur. Radiol. (2002) Abstract Blunt traumatic aortic injuries are a major concern in the settings of high-speed deceleration accidents, since they are associated with a very high mortality rate; however, with prompt diagnosis and surgery, 70 % of the patients with a blunt aortic lesion who reach the hospital alive will survive. This statement challenges the emergency radiologist in charge to evaluate the admission radiological survey in a severe chest trauma patient. With a 95 % negative predictive value for the identification of blunt traumatic aortic lesions, plain chest film represents an adequate screening test. If aortography remains the gold standard, it tends, at least in hemodynamically stable trauma patients, to be replaced by spiral-CT angiography (SCTA), which demonstrates a 96.2 % sensitivity, a 99.8 % specificity, and a 99.7 % accuracy. In unstable patients, trans-esophageal echography (TEE) plays a major diagnostic role. Knowledge of advantages and pitfalls of these imaging techniques, as reviewed in this article, will help the emergency radiologist to choose the appropriate algorithm in the diagnosis of traumatic aortic injury, for each trauma patient.Keywords Wounds and injuriesT horacic injuries´Aortic ruptureD iagnostic imaging´X-ray CTÉ mergency tr...

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Transesophageal Echocardiography for Diagnosis and Treatment of Aortic Diseases

Massabuau

Thoracic Aortic Diseases

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Use of Transesophageal Echocardiography for Diagnosis of Traumatic Aortic Injury

Cited by 61 publications

References 24 publications

Echocardiography in Special Situations

Echocardiography in Special Situations

Imaging of acute traumatic injuries of the thoracic aorta

Transesophageal Echocardiography for Diagnosis and Treatment of Aortic Diseases

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