Transmediastinal gunshot wounds. A reconsideration of the role of aortography

E. E. Cornwell 3rd, F. Kennedy, I. A. Ayad, T. V. Berne, G. Velmahos, J. Asensio and D. Demetriades
Department of Surgery, University of Southern California School of Medicine, USA.

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.