753-4 Transesophageal Echocardiography in Patients with Blunt Chest Trauma

Rupture of the aorta resulting from blunt chest trauma (BCT) is often fatal. Early diagnosis and surgical treatment improves the chances of survival. Transesophageal echocardiography (TEE) permits accurate and rapid visualization of the thoracic aorta and is ideal in evaluating such patients. We performed TEE as the initial diagnostic procedure in 141 patients (pts) with BCT. 90% had a widened mediastinum on chest x-ray (CXR) as an indication of possible aortic damage. 92% of studies were performed in the emergency room. Sixty pts were on mechanical ventilatory support. Passage of the scope was difficult in 2 pts. Nine developed transient hypoxemia, one requiring mechanical ventilation. Findings 116 pts (82%) had no evidence of aortic trauma on TEE. Aortic disruption was noted in 6 pts (4%). 5 of whom underwent surgery and survived. In 15 pts the findings were indeterminate. Aortogram in these pts were negative for trauma. Disruption involving the distal arch was missed in 2 pts. Both died. Conclusions (1) TEE may be safely and rapidly performed in pts with BCT despite a high proportion being critically ill. (2) Alow yield of aortic disruption is obtained when the pre-test probability is low. (3) Early identification of aortic disruption by TEE and prompt surgical management improves survival. (4) Correct identification of disruption may be difficult in some cases where there is inadequate visualization of the aorta. (5) The diagnostic accuracy in identifying aortic disruption may be improved by the newer multiplanar TEE imaging modalities and by increasing operator experience with TEE in BCT pts, making this the procedure of choice in cases of suspected aortic disruption.