Use of transesophageal echocardiography for the assessment of traumatic aortic injuries

Acute traumatic lesions of the thoracic aorta or its branches (TLA) constit ute highly lethal yet tl eatable injuries that are increasingly diagnosed i n surviving patients. Traumatic disruptions are limited to the region of th e aortic isthmus in similar to 90% of cases. Unlike aortography, usually re ferred as the gold standard diagnostic technique, transesophageal echocardi ography (TEE) is a noninvasive imaging modality that can be rapidly perform ed at the patient bedside. Accordingly, TEE is being increasingly used as a first-line screening test for the evaluation, of patients with suspected T LA. The TEE signs associated with TLA depend on the anatomic type of aortic disruption. After a period of validation, multiplane TEE allows accurate d iagnosis of traumatic disruptions of the aortic isthmus, with a sensitivity of 88% (range, 57%-100%) and a specificity of 96% (range, 84%-100%). False -negative TEE results have been mainly attributed to lacerations of aortic branches. Accordingly, aortography must be routinely performed when a traum atic injury to brachiocephalic arteries is suspected. False-positive TEE fi ndings ha ve been associated with the presence of ultrasound artifacts or a therosclerotic changes that mimic TLA. Accurate determination of the depth of aortic wall tears and diagnosis of blunt cardiac injuries during the TEE study are crucial to guide patient management. The presence of TEE signs a ssociated with imminent risk of adventitial rupture should lead to prompt s urgery. The use of TEE as a first-line imaging modality simplifies the init ial assessment of patients at high risk for TLA and helps guide acute manag ement.