SYSTEMATIC TRANSESOPHAGEAL ECHOCARDIOGRAPHY FOR DETECTION OF MEDIASTINAL LESIONS IN PATIENTS WITH MULTIPLE INJURIES

A prospective study assessing the interest in and the results of syste matic transesophageal echocardiography (TEE) examination in nonselecte d intubated multiple injury patients was carried out from January 1992 through June 1993. Seventy patients were included and divided into tw o groups according to the results of admission screening, including cl inical examination, EKG, CK-MB and chest radiograph. Group 1 (60 patie nts) had abnormalities on initial screening, while group 2 (10 patient s) had no symptom of thoracic or mediastinal injury. TEE was performed within 48 hours following admission and its results were compared wit h those of the initial screening. TEE usefulness was evaluated on a sc ore grade from 0 (no interest) to 4 (outstanding interest). Myocardial contusion was suspected in 25 patients. TEE invalidated 18 suspected and found 5 unsuspected myocardial contusions. Pericardial effusion wa s suspected in only one case, while TEE documented 13 additional cases . A mediastinal enlargement was seen in 13 patients, but TEE invalidat ed aortic lesions in all these cases and made an unsuspected diagnosis of aortic tears. Eight cases of severe hypovolemia and seven cases of left ventricle dysfunction were detected by TEE. The score of interes t shelved that TEE allowed new interesting diagnoses in 70% of group I patients and in 33% of group II patients. TEE is of utmost importance in multiple injury patients, with or without any evidence of thoracic or mediastinal injury, providing a safe and rapid examination of the mediastinal structures and an evaluation of the hemodynamic status.