TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN THE DIAGNOSIS OF TRAUMATIC RUPTURE OF THE AORTA

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 patien ts at risk for aortic injury. Methods. Transesophageal echocardiograph y of the aorta was attempted in 101 patients admitted to the emergency room with a diagnosis of possible traumatic rupture of the aorta. Ech ocardiography and aortography personnel were notified simultaneously o f the arrival of the patient, and the two tests were performed sequent ially by operators who were blinded to the results of the other test. The sensitivity and specificity of transesophageal echocardiography we re calculated on the basis of the results of aortography of the arch, surgery, or topsy. tempted in 101 patients. The study was successfully performed in 93 patients but could not be completed in 8 because of l ack of cooperation on the part of the patient (7 patients) or maxillof acial trauma (1 patient). Despite a high injury-severity score (mean, 29.6), transesophageal echocardiography was performed without complica tions, and within a mean (+/-SD) of 29+/-12 minutes. Eleven of the 93 studies (12 percent) demonstrated rupture of the aorta near the isthmu s. 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 det ection of injury to the aorta. There was one false positive echocardio gram. Conclusions. Transesophageal echocardiography is a highly sensit ive and specific method of detecting injury to the thoracic aorta. Thi s technique can be used safely and quickly in critically injured patie nts with suspected traumatic rupture of the aorta and compares favorab ly with arch aortography.