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.