Use of Transesophageal Echocardiography and Compound Tomography in Diagnosing Aortic Injuries Resulting from Blunt Trauma.Vignon et al. (page 615)

Although multiplane transesophageal echocardiography (TEE) and helical compound tomography (CT) of the chest have been evaluated in comparison with aortography for their sensitivity in detecting acute traumatic aortic injuries, the two techniques have not been compared with each other. Accordingly, Vignon et al.  conducted a prospective study to determine the diagnostic accuracy of the two methods for detecting traumatic cardiovascular injuries. During a 3-yr period, the authors examined 285 patients admitted for blunt trauma to their institution. After initial examination, 110 (88 men and 22 women) were considered to be at high risk of having sustained a traumatic cardiovascular injury. A total of 95 patients underwent both TEE and CT, and a traumatic arterial injury was diagnosed in 17 patients (15.5%). All acute traumatic aortic injuries involved the aortic isthmus, except for one subadventitial disruption of the ascending aorta. Both TEE and CT identified all subadventitial disruptions of the aortic isthmus or ascending aorta that required surgical repair. Two patients died before surgery, but the remaining patients all underwent successful surgical repair. CT only depicted one disruption of the innominate artery. TEE was more sensitive than CT for the identification of intimal or medial lesions of the thoracic aorta. In cases in which hemodynamically unstable patients cannot be transported safely to the radiology department, TEE may offer a safe alternative for ruling out acute traumatic aortic injuries at the bedside.