Comparison of multiplane transesophageal echocardiography and contrast-enhanced helical CT in the diagnosis of blunt traumatic cardiovascular injuries

Background: Multiplane transesophageal echocardiography (TEE) and helical c omputed tomography (CT) of the chest have been validated separately against aortography for the diagnosis of acute traumatic aortic injuries (ATAI), H owever, their respective diagnostic accuracy in identifying blunt traumatic cardiovascular lesions has not been compared. Methods: During a 3-yr period, 110 consecutive patients with severe blunt c hest trauma (age: 41 +/- 17 yr; injury severity score: 34 +/- 14) prospecti vely underwent TEE and chest CT as part of their initial evaluation. Result s of both imaging methods were interpreted independently by experienced inv estigators and subsequently compared. All cases of subadventitial acute tra umatic aortic injury were surgically confirmed. Results: Seventeen patients had vascular injury and 11 had cardiac lesions. TEE and CT identified all subadventitial disruptions involving the aortic isthmus (n = 10) or the ascending aorta (n = 1) that necessitated surgical repair. In contrast, CT only depicted one disruption of the innominate arte ry. TEE detected injuries involving the intimal or medial layer, or both, o f the aortic isthmus in four patients with apparently normal CT results who underwent successful conservative treatment. All cardiac injuries but two were identified only by TEE. Conclusions: In patients with severe blunt chest trauma, TEE and CT have si milar diagnostic accuracy for the identification of surgical acute traumati c aortic injury, TEE also allows the diagnosis of associated cardiac injuri es and is more sensitive than CT for the identification of intimal or media l lesions of the thoracic aorta.