Transmediastinal Gunshot WoundsA Reconsideration of the Role of Aortography
Edward E. Cornwell, III, MD;
Frank Kennedy, MD;
Ihab A. Ayad, MD;
Thomas V. Berne, MD;
George Velmahos, MD, PhD;
Juan Asensio, MD;
Demetrios Demetriades, MD, PhD
Arch Surg. 1996;131(9):949-953.
Abstract
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Objective
To evaluate the contribution of aortography in the management of stable patients with transmediastinal gunshot wounds.
Design
Retrospective review of clinical records.
Setting
Level I urban trauma center.
Patients
Forty-three patients with aortic or esophageal gunshot injuries.
Interventions
Patients who were stable after initial resuscitation underwent aortography followed by esophagography.
Main Outcome Measures
Hemodynamic status on admission, time devoted to diagnostic workup, surgical (or autopsy) findings, morbidity, and mortality.
Results
There were 24 esophageal injuries and 20 aortic injuries. Patients with aortic injuries were less often stable for aortography (10% vs 42%; P=.02), and fewer of them survived (15% vs 58%; P=.01). In no patient was the aortic injury initially detected by aortography. Stable patients with esophageal injuries experienced an average 11-hour interval between injury and surgery (nearly 3 hours attributable to aortography).
Conclusion
Esophageal evaluation should precede aortography in the workup of stable patients with transmediastinal gunshot wounds.
Arch Surg. 1996;131:949-953
Author Affiliations
From the Department of Surgery, University of Southern California School of Medicine and Los Angeles County+ University of Southern California Medical Center, Los Angeles.
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ABSTRACT
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