Helical computed tomographic scan in the evaluation of mediastinal gunshot wounds

D. E. Hanpeter, D. Demetriades, Juan A. Asensio, T. V. Berne, G. Velmahos, J. Murray, E. E. Moore, C. W. Schwab, R. Ivatury, K. K. Nagy

Research output: Contribution to journalArticle

62 Citations (Scopus)

Abstract

Background: The standard evaluation of mediastinal gunshot wounds usually requires angiography and either esophagoscopy or esophagography. In the present study, we have evaluated the role of helical computed tomographic (CT) scanning in reducing the need for angiographic and esophageal studies. Methods: This was a prospective study of patients with mediastinal gunshot wounds who were hemodynamically stable and would otherwise require angiography and esophageal evaluation. All patients underwent CT scan of the chest with intravenous contrast to delineate the missile trajectory. If the missile tract was in close proximity to the aorta, great vessels, or esophagus, then traditional evaluation with angiographic or esophageal evaluation was pursued. Results: A total of 24 patients met the inclusion criteria and underwent CT scan evaluation of their mediastinal gunshot wounds. One patient was taken for sternotomy to remove a missile embedded in the myocardium solely on the basis of the result of the CT scan. Because of proximity of the bullet tract, 12 patients required additional evaluation with eight angiograms and nine esophageal studies. One of these patients had a positive angiogram (bullet resting against the ascending aorta) and underwent sternotomy for missile removal; all other studies were negative. The remaining 11 patients were found to have well-defined missile tracts that approached neither the aorta nor the esophagus, and no additional evaluation was pursued. There were no missed mediastinal injuries in this group. Overall, 12 of 24 patients (50%) had a change in management (either received an operation or avoided additional radiographic or endoscopic evaluation) on the basis of the CT scan. Conclusion: The helical CT scan provides a rapid, readily available, noninvasive means to evaluate missile trajectories. This permits accurate assessment of potential mediastinal injury and reduces the need for routine angiographic and esophageal studies.

Original languageEnglish
Pages (from-to)689-695
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume49
Issue number4
StatePublished - 2000
Externally publishedYes

Fingerprint

Gunshot Wounds
Angiography
Aorta
Sternotomy
Esophagus
Esophagoscopy
Wounds and Injuries
Myocardium
Thorax
Prospective Studies

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Hanpeter, D. E., Demetriades, D., Asensio, J. A., Berne, T. V., Velmahos, G., Murray, J., ... Nagy, K. K. (2000). Helical computed tomographic scan in the evaluation of mediastinal gunshot wounds. Journal of Trauma - Injury, Infection and Critical Care, 49(4), 689-695.

Helical computed tomographic scan in the evaluation of mediastinal gunshot wounds. / Hanpeter, D. E.; Demetriades, D.; Asensio, Juan A.; Berne, T. V.; Velmahos, G.; Murray, J.; Moore, E. E.; Schwab, C. W.; Ivatury, R.; Nagy, K. K.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 49, No. 4, 2000, p. 689-695.

Research output: Contribution to journalArticle

Hanpeter, DE, Demetriades, D, Asensio, JA, Berne, TV, Velmahos, G, Murray, J, Moore, EE, Schwab, CW, Ivatury, R & Nagy, KK 2000, 'Helical computed tomographic scan in the evaluation of mediastinal gunshot wounds', Journal of Trauma - Injury, Infection and Critical Care, vol. 49, no. 4, pp. 689-695.
Hanpeter, D. E. ; Demetriades, D. ; Asensio, Juan A. ; Berne, T. V. ; Velmahos, G. ; Murray, J. ; Moore, E. E. ; Schwab, C. W. ; Ivatury, R. ; Nagy, K. K. / Helical computed tomographic scan in the evaluation of mediastinal gunshot wounds. In: Journal of Trauma - Injury, Infection and Critical Care. 2000 ; Vol. 49, No. 4. pp. 689-695.
@article{e8e18ab87b924d8fbf6cd326bb001cb5,
title = "Helical computed tomographic scan in the evaluation of mediastinal gunshot wounds",
abstract = "Background: The standard evaluation of mediastinal gunshot wounds usually requires angiography and either esophagoscopy or esophagography. In the present study, we have evaluated the role of helical computed tomographic (CT) scanning in reducing the need for angiographic and esophageal studies. Methods: This was a prospective study of patients with mediastinal gunshot wounds who were hemodynamically stable and would otherwise require angiography and esophageal evaluation. All patients underwent CT scan of the chest with intravenous contrast to delineate the missile trajectory. If the missile tract was in close proximity to the aorta, great vessels, or esophagus, then traditional evaluation with angiographic or esophageal evaluation was pursued. Results: A total of 24 patients met the inclusion criteria and underwent CT scan evaluation of their mediastinal gunshot wounds. One patient was taken for sternotomy to remove a missile embedded in the myocardium solely on the basis of the result of the CT scan. Because of proximity of the bullet tract, 12 patients required additional evaluation with eight angiograms and nine esophageal studies. One of these patients had a positive angiogram (bullet resting against the ascending aorta) and underwent sternotomy for missile removal; all other studies were negative. The remaining 11 patients were found to have well-defined missile tracts that approached neither the aorta nor the esophagus, and no additional evaluation was pursued. There were no missed mediastinal injuries in this group. Overall, 12 of 24 patients (50{\%}) had a change in management (either received an operation or avoided additional radiographic or endoscopic evaluation) on the basis of the CT scan. Conclusion: The helical CT scan provides a rapid, readily available, noninvasive means to evaluate missile trajectories. This permits accurate assessment of potential mediastinal injury and reduces the need for routine angiographic and esophageal studies.",
author = "Hanpeter, {D. E.} and D. Demetriades and Asensio, {Juan A.} and Berne, {T. V.} and G. Velmahos and J. Murray and Moore, {E. E.} and Schwab, {C. W.} and R. Ivatury and Nagy, {K. K.}",
year = "2000",
language = "English",
volume = "49",
pages = "689--695",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Helical computed tomographic scan in the evaluation of mediastinal gunshot wounds

AU - Hanpeter, D. E.

AU - Demetriades, D.

AU - Asensio, Juan A.

AU - Berne, T. V.

AU - Velmahos, G.

AU - Murray, J.

AU - Moore, E. E.

AU - Schwab, C. W.

AU - Ivatury, R.

AU - Nagy, K. K.

PY - 2000

Y1 - 2000

N2 - Background: The standard evaluation of mediastinal gunshot wounds usually requires angiography and either esophagoscopy or esophagography. In the present study, we have evaluated the role of helical computed tomographic (CT) scanning in reducing the need for angiographic and esophageal studies. Methods: This was a prospective study of patients with mediastinal gunshot wounds who were hemodynamically stable and would otherwise require angiography and esophageal evaluation. All patients underwent CT scan of the chest with intravenous contrast to delineate the missile trajectory. If the missile tract was in close proximity to the aorta, great vessels, or esophagus, then traditional evaluation with angiographic or esophageal evaluation was pursued. Results: A total of 24 patients met the inclusion criteria and underwent CT scan evaluation of their mediastinal gunshot wounds. One patient was taken for sternotomy to remove a missile embedded in the myocardium solely on the basis of the result of the CT scan. Because of proximity of the bullet tract, 12 patients required additional evaluation with eight angiograms and nine esophageal studies. One of these patients had a positive angiogram (bullet resting against the ascending aorta) and underwent sternotomy for missile removal; all other studies were negative. The remaining 11 patients were found to have well-defined missile tracts that approached neither the aorta nor the esophagus, and no additional evaluation was pursued. There were no missed mediastinal injuries in this group. Overall, 12 of 24 patients (50%) had a change in management (either received an operation or avoided additional radiographic or endoscopic evaluation) on the basis of the CT scan. Conclusion: The helical CT scan provides a rapid, readily available, noninvasive means to evaluate missile trajectories. This permits accurate assessment of potential mediastinal injury and reduces the need for routine angiographic and esophageal studies.

AB - Background: The standard evaluation of mediastinal gunshot wounds usually requires angiography and either esophagoscopy or esophagography. In the present study, we have evaluated the role of helical computed tomographic (CT) scanning in reducing the need for angiographic and esophageal studies. Methods: This was a prospective study of patients with mediastinal gunshot wounds who were hemodynamically stable and would otherwise require angiography and esophageal evaluation. All patients underwent CT scan of the chest with intravenous contrast to delineate the missile trajectory. If the missile tract was in close proximity to the aorta, great vessels, or esophagus, then traditional evaluation with angiographic or esophageal evaluation was pursued. Results: A total of 24 patients met the inclusion criteria and underwent CT scan evaluation of their mediastinal gunshot wounds. One patient was taken for sternotomy to remove a missile embedded in the myocardium solely on the basis of the result of the CT scan. Because of proximity of the bullet tract, 12 patients required additional evaluation with eight angiograms and nine esophageal studies. One of these patients had a positive angiogram (bullet resting against the ascending aorta) and underwent sternotomy for missile removal; all other studies were negative. The remaining 11 patients were found to have well-defined missile tracts that approached neither the aorta nor the esophagus, and no additional evaluation was pursued. There were no missed mediastinal injuries in this group. Overall, 12 of 24 patients (50%) had a change in management (either received an operation or avoided additional radiographic or endoscopic evaluation) on the basis of the CT scan. Conclusion: The helical CT scan provides a rapid, readily available, noninvasive means to evaluate missile trajectories. This permits accurate assessment of potential mediastinal injury and reduces the need for routine angiographic and esophageal studies.

UR - http://www.scopus.com/inward/record.url?scp=0033770184&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033770184&partnerID=8YFLogxK

M3 - Article

VL - 49

SP - 689

EP - 695

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 4

ER -