DIAGNOSIS OF TRAUMATIC MEDIASTINAL HEMATOMA WITH TRANSESOPHAGEAL ECHOCARDIOGRAPHY

In patients with blunt chest trauma, early diagnosis of mediastinal he matoma is important, because it could be associated with thoracic vess el injury. Mediastinal hematoma is generally evoked because of a widen ed mediastinum on chest radiograph, but radiologic diagnosis may lead to excessive angiography being performed. Transesophageal echocardiogr aphy (TEE) provides accurate views of the mediastinum and can be rapid ly performed at the bedside. Thus, we conducted a prospective study to define TEE signs of mediastinal hematoma. TEE was performed in 22 tho racic trauma patients (trauma group) and in 20 brain-dead patients wit hout thoracic trauma (control group). The positive diagnosis of medias tinal hematoma was made using thoracic surgery or computed tomographic scan. The specificity of TEE was 75 percent and sensitivity was 100 p ercent. In the trauma group, there was only one false positive but ang iography discovered a traumatic aneurysm of the proximal right subclav ian artery. No false negative was noted. We described three different TEE signs of mediastinal hematoma: (1) an increased distance between t he probe and the aortic wall; (2) a double contour of the aortic wall; and (3) visualization of the ultrasound signal between the aortic wal l and the visceral pleura. The distance between the esophageal probe a nd the aortic wall was the most accurate sign because it could be easi ly obtained; the threshold value for this distance was 3 mm. TEE appea rs to be an accurate method to diagnose traumatic mediastinal hematoma .