TRANSMEDIASTINAL GUNSHOT WOUNDS - A RECONSIDERATION OF THE ROLE OF AORTOGRAPHY

Objective: To evaluate the contribution of aortography in the manageme nt of stable patients with transmediastinal gunshot wounds. Design: Re trospective review of clinical records. Setting: Level I urban trauma center. Patients: Forty-three patients with aortic or esophageal gunsh ot injuries. Interventions: Patients who were stable after initial res uscitation underwent aortography followed by esophagography. Main Outc ome Measures: Hemodynamic status on admission, time devoted to diagnos tic workup, surgical (or autopsy) findings, morbidity, and mortality. Results: There were 24 esophageal injuries and 20 aortic injuries. Pat ients with aortic injuries were less often stable for aortography (10% vs 42%; P=.02), and fewer of them survived (15% vs 58%; P=.01). In no patient was the aortic injury initially detected by aortography. Stab le patients with esophageal injuries experienced an average 11-hour in terval between injury and surgery (nearly 3 hours attributable to aort ography). Conclusion: Esophageal evaluation should precede aortography in the workup of stable patients with transmediastinal gunshot wounds .