Transmediastinal gunshot wounds. A reconsideration of the role of aortography.

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.

[1]  D. Demetriades,et al.  Gunshot wounds to the thoracic aorta in the '90s: only prevention will make a difference. , 1995, The American surgeon.

[2]  D. Demetriades,et al.  Aortoesophageal fistulae due to gunshot wounds: report of two cases with one survivor. , 1995, The Journal of trauma.

[3]  S. Norwood,et al.  Thoracic BB injuries in pediatric patients. , 1995, The Journal of trauma.

[4]  W. Armstrong,et al.  Diagnosis and Management of External Penetrating Cervical Esophageal Injuries , 1994, The Annals of otology, rhinology, and laryngology.

[5]  R. McMILLAN,et al.  Major Vascular Injuries of the Torso , 1992, Southern medical journal.

[6]  D. Morris,et al.  Diagnosis and management of esophageal perforations. , 1992, The American surgeon.

[7]  G. Timberlake,et al.  Penetrating Thoracic Aortic Injuries: Rare but Potentially Salvageable Sequelae of Urban Warfare , 1989, Southern medical journal.

[8]  Stiles Gm,et al.  Injuries to the ascending aorta, aortic arch and great vessels. , 1989 .

[9]  Y. Ben-menachem,et al.  Penetrating injuries of the thoracic aorta and brachiocephalic arteries: angiographic findings in 18 cases. , 1987, AJR. American journal of roentgenology.

[10]  A. Yellin,et al.  Management of injuries of the thoracic and abdominal aorta. , 1985, American journal of surgery.

[11]  J. Jones,et al.  The fuzzy foreign body fragment: a subtle roentgenographic clue to mediastinal vascular injury. , 1985, American journal of surgery.

[12]  J. Popovsky.  Perforations of the esophagus from gunshot wounds. , 1984, The Journal of trauma.

[13]  L. Gray,et al.  Management of transmediastinal gunshot wounds. , 1981, Surgery.

[14]  M. Debakey,et al.  Surgical management of penetrating injuries of the esophagus , 1977 .

[15]  M. Debakey,et al.  Penetrating wounds of the cervical esophagus. , 1975, American journal of surgery.

[16]  A. Beall,et al.  The surgical management of acute injury to the thoracic aorta. , 1974, The Journal of thoracic and cardiovascular surgery.

[17]  P. Symbas,et al.  Penetrating Wounds of the Thoracic Aorta , 1970, Annals of surgery.