Routine helical computed tomographic evaluation of the mediastinum in high-risk blunt trauma patients

Demetrios Demetriades, Hugo Gomez, George C. Velmahos, Juan A. Asensio, James Murray, Edward E. Cornwell, Kathleen Alo, Thomas V. Berne

Research output: Contribution to journalArticle

111 Citations (Scopus)

Abstract

Background: The indications and method of evaluation of the mediastinum in blunt deceleration trauma are controversial and vary among centers. Most centers practice a policy of angiographic evaluation only in the presence of an abnormal mediastinum on chest radiography. Routine aortography in the absence of any mediastinal abnormality is not widely practiced. Helical computed tomographic (CT) scan has been successfully used in recent studies in the evaluation of the thoracic aorta. Objective: To determine the role of routine helical CT scan evaluation of the mediastinum in patients involved in high-speed deceleration injuries, irrespective of chest radiographic findings. Design: A prospective study over a 1-year period. Included in the study were patients with high-speed deceleration injuries who required CT evaluation of the head or abdomen. This group of patients underwent routine helical CT evaluation of the mediastinum irrespective of chest radiographic findings. Setting: Large, urban, academic level 1 trauma center. Results: A total of 112 trauma patients fulfilled the criteria for study inclusion. Overall, there were 9 patients (8.0%) with aortic rupture. Four (44.4%) of these patients had a normal mediastinum on the initial chest x-ray film and the diagnosis was made by CT scan. The CT scan was diagnostic in 8 of the aortic ruptures (intimal tear or psuedoaneurysm) and was suggestive of aortic in jury but not diagnostic in 1 patient with brachiocephalic artery injury. In 42 patients (37.5%), there was a widened mediastinum: an aortic rupture was diagnosed in 5 of them (11.9%) and a spinal fracture in 9 (21.4%) One patient had both aortic rupture and spinal injury. Conclusions: The incidence of aortic injury in patients with high-speed deceleration injury is high. A significant proportion of patients with aortic injury have a normal mediastinum on the initial chest radiograph. There is a high incidence of spinal injuries in the presence of a widened mediastinum. We recommend that all trauma patients with high-risk deceleration injuries undergo routine helical CT evaluation of the mediastinum irrespective of chest radiographic findings.

Original languageEnglish
Pages (from-to)1084-1088
Number of pages5
JournalArchives of Surgery
Volume133
Issue number10
DOIs
StatePublished - Oct 1998
Externally publishedYes

Fingerprint

Mediastinum
Wounds and Injuries
Deceleration
Aortic Rupture
Thorax
Spinal Injuries
Spinal Fractures
Tunica Intima
Aortography
Thoracic Injuries
Trauma Centers
Incidence
Motion Pictures
Thoracic Aorta
Radiography
Abdomen
Arteries
Head
X-Rays
Prospective Studies

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Demetriades, D., Gomez, H., Velmahos, G. C., Asensio, J. A., Murray, J., Cornwell, E. E., ... Berne, T. V. (1998). Routine helical computed tomographic evaluation of the mediastinum in high-risk blunt trauma patients. Archives of Surgery, 133(10), 1084-1088. https://doi.org/10.1001/archsurg.133.10.1084

Routine helical computed tomographic evaluation of the mediastinum in high-risk blunt trauma patients. / Demetriades, Demetrios; Gomez, Hugo; Velmahos, George C.; Asensio, Juan A.; Murray, James; Cornwell, Edward E.; Alo, Kathleen; Berne, Thomas V.

In: Archives of Surgery, Vol. 133, No. 10, 10.1998, p. 1084-1088.

Research output: Contribution to journalArticle

Demetriades, D, Gomez, H, Velmahos, GC, Asensio, JA, Murray, J, Cornwell, EE, Alo, K & Berne, TV 1998, 'Routine helical computed tomographic evaluation of the mediastinum in high-risk blunt trauma patients', Archives of Surgery, vol. 133, no. 10, pp. 1084-1088. https://doi.org/10.1001/archsurg.133.10.1084
Demetriades, Demetrios ; Gomez, Hugo ; Velmahos, George C. ; Asensio, Juan A. ; Murray, James ; Cornwell, Edward E. ; Alo, Kathleen ; Berne, Thomas V. / Routine helical computed tomographic evaluation of the mediastinum in high-risk blunt trauma patients. In: Archives of Surgery. 1998 ; Vol. 133, No. 10. pp. 1084-1088.
@article{d24212f5c1f84ef2a6166837d01358fd,
title = "Routine helical computed tomographic evaluation of the mediastinum in high-risk blunt trauma patients",
abstract = "Background: The indications and method of evaluation of the mediastinum in blunt deceleration trauma are controversial and vary among centers. Most centers practice a policy of angiographic evaluation only in the presence of an abnormal mediastinum on chest radiography. Routine aortography in the absence of any mediastinal abnormality is not widely practiced. Helical computed tomographic (CT) scan has been successfully used in recent studies in the evaluation of the thoracic aorta. Objective: To determine the role of routine helical CT scan evaluation of the mediastinum in patients involved in high-speed deceleration injuries, irrespective of chest radiographic findings. Design: A prospective study over a 1-year period. Included in the study were patients with high-speed deceleration injuries who required CT evaluation of the head or abdomen. This group of patients underwent routine helical CT evaluation of the mediastinum irrespective of chest radiographic findings. Setting: Large, urban, academic level 1 trauma center. Results: A total of 112 trauma patients fulfilled the criteria for study inclusion. Overall, there were 9 patients (8.0{\%}) with aortic rupture. Four (44.4{\%}) of these patients had a normal mediastinum on the initial chest x-ray film and the diagnosis was made by CT scan. The CT scan was diagnostic in 8 of the aortic ruptures (intimal tear or psuedoaneurysm) and was suggestive of aortic in jury but not diagnostic in 1 patient with brachiocephalic artery injury. In 42 patients (37.5{\%}), there was a widened mediastinum: an aortic rupture was diagnosed in 5 of them (11.9{\%}) and a spinal fracture in 9 (21.4{\%}) One patient had both aortic rupture and spinal injury. Conclusions: The incidence of aortic injury in patients with high-speed deceleration injury is high. A significant proportion of patients with aortic injury have a normal mediastinum on the initial chest radiograph. There is a high incidence of spinal injuries in the presence of a widened mediastinum. We recommend that all trauma patients with high-risk deceleration injuries undergo routine helical CT evaluation of the mediastinum irrespective of chest radiographic findings.",
author = "Demetrios Demetriades and Hugo Gomez and Velmahos, {George C.} and Asensio, {Juan A.} and James Murray and Cornwell, {Edward E.} and Kathleen Alo and Berne, {Thomas V.}",
year = "1998",
month = "10",
doi = "10.1001/archsurg.133.10.1084",
language = "English",
volume = "133",
pages = "1084--1088",
journal = "JAMA Surgery",
issn = "2168-6254",
publisher = "American Medical Association",
number = "10",

}

TY - JOUR

T1 - Routine helical computed tomographic evaluation of the mediastinum in high-risk blunt trauma patients

AU - Demetriades, Demetrios

AU - Gomez, Hugo

AU - Velmahos, George C.

AU - Asensio, Juan A.

AU - Murray, James

AU - Cornwell, Edward E.

AU - Alo, Kathleen

AU - Berne, Thomas V.

PY - 1998/10

Y1 - 1998/10

N2 - Background: The indications and method of evaluation of the mediastinum in blunt deceleration trauma are controversial and vary among centers. Most centers practice a policy of angiographic evaluation only in the presence of an abnormal mediastinum on chest radiography. Routine aortography in the absence of any mediastinal abnormality is not widely practiced. Helical computed tomographic (CT) scan has been successfully used in recent studies in the evaluation of the thoracic aorta. Objective: To determine the role of routine helical CT scan evaluation of the mediastinum in patients involved in high-speed deceleration injuries, irrespective of chest radiographic findings. Design: A prospective study over a 1-year period. Included in the study were patients with high-speed deceleration injuries who required CT evaluation of the head or abdomen. This group of patients underwent routine helical CT evaluation of the mediastinum irrespective of chest radiographic findings. Setting: Large, urban, academic level 1 trauma center. Results: A total of 112 trauma patients fulfilled the criteria for study inclusion. Overall, there were 9 patients (8.0%) with aortic rupture. Four (44.4%) of these patients had a normal mediastinum on the initial chest x-ray film and the diagnosis was made by CT scan. The CT scan was diagnostic in 8 of the aortic ruptures (intimal tear or psuedoaneurysm) and was suggestive of aortic in jury but not diagnostic in 1 patient with brachiocephalic artery injury. In 42 patients (37.5%), there was a widened mediastinum: an aortic rupture was diagnosed in 5 of them (11.9%) and a spinal fracture in 9 (21.4%) One patient had both aortic rupture and spinal injury. Conclusions: The incidence of aortic injury in patients with high-speed deceleration injury is high. A significant proportion of patients with aortic injury have a normal mediastinum on the initial chest radiograph. There is a high incidence of spinal injuries in the presence of a widened mediastinum. We recommend that all trauma patients with high-risk deceleration injuries undergo routine helical CT evaluation of the mediastinum irrespective of chest radiographic findings.

AB - Background: The indications and method of evaluation of the mediastinum in blunt deceleration trauma are controversial and vary among centers. Most centers practice a policy of angiographic evaluation only in the presence of an abnormal mediastinum on chest radiography. Routine aortography in the absence of any mediastinal abnormality is not widely practiced. Helical computed tomographic (CT) scan has been successfully used in recent studies in the evaluation of the thoracic aorta. Objective: To determine the role of routine helical CT scan evaluation of the mediastinum in patients involved in high-speed deceleration injuries, irrespective of chest radiographic findings. Design: A prospective study over a 1-year period. Included in the study were patients with high-speed deceleration injuries who required CT evaluation of the head or abdomen. This group of patients underwent routine helical CT evaluation of the mediastinum irrespective of chest radiographic findings. Setting: Large, urban, academic level 1 trauma center. Results: A total of 112 trauma patients fulfilled the criteria for study inclusion. Overall, there were 9 patients (8.0%) with aortic rupture. Four (44.4%) of these patients had a normal mediastinum on the initial chest x-ray film and the diagnosis was made by CT scan. The CT scan was diagnostic in 8 of the aortic ruptures (intimal tear or psuedoaneurysm) and was suggestive of aortic in jury but not diagnostic in 1 patient with brachiocephalic artery injury. In 42 patients (37.5%), there was a widened mediastinum: an aortic rupture was diagnosed in 5 of them (11.9%) and a spinal fracture in 9 (21.4%) One patient had both aortic rupture and spinal injury. Conclusions: The incidence of aortic injury in patients with high-speed deceleration injury is high. A significant proportion of patients with aortic injury have a normal mediastinum on the initial chest radiograph. There is a high incidence of spinal injuries in the presence of a widened mediastinum. We recommend that all trauma patients with high-risk deceleration injuries undergo routine helical CT evaluation of the mediastinum irrespective of chest radiographic findings.

UR - http://www.scopus.com/inward/record.url?scp=0031755681&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031755681&partnerID=8YFLogxK

U2 - 10.1001/archsurg.133.10.1084

DO - 10.1001/archsurg.133.10.1084

M3 - Article

VL - 133

SP - 1084

EP - 1088

JO - JAMA Surgery

JF - JAMA Surgery

SN - 2168-6254

IS - 10

ER -