Vignon P, Guéret P, Vedrinne J M, Lagrange P, Cornu E, Abrieu O, Gastinne H, Bensaid J, Lang R M
Department of Intensive Care, Dupuytren Hospital, Limoges, France.
Circulation. 1995 Nov 15;92(10):2959-68. doi: 10.1161/01.cir.92.10.2959.
Traumatic disruption of the aorta (TDA) is a life-threatening injury that requires rapid diagnosis and treatment. Emergency aortography, which is the current standard diagnostic imaging modality, is invasive, time-consuming, and difficult to perform in hemodynamically unstable patients with multiple trauma. We performed transesophageal echocardiography (TEE) in patients with suspected TDA to determine the diagnostic accuracy and impact on patient management of this alternative, portable imaging modality.
Thirty-two consecutive trauma patients (mean age, 40 +/- 16 years) with suspected TDA (violent deceleration accident and mediastinum > 8 cm on admission chest x-ray) prospectively underwent a TEE examination in the emergency room. Findings during TEE were compared with those encountered during aortography, surgery, or necropsy. Two subsets of traumatic aortic injuries with distinct echocardiographic signs were observed: (1) subadventitial TDA (n = 10) and (2) traumatic intimal tears (n = 3). Eighteen patients had normal TEE confirmed by aortography. One 2-mm medial tear was missed by TEE (necropsy). The sensitivity and specificity of TEE for the diagnosis of subadventitial TDA were 91% and 100%, respectively. Patients with subadventitial TDA were taken to surgery immediately, whereas patients with intimal aortic tears were treated conservatively. Eighteen patients (mean age, 57 +/- 15 years) with confirmed acute aortic dissection involving the aortic isthmus were also included to establish the echocardiographic differential diagnostic criteria between this entity and TDA.
TEE should be considered the first-line imaging modality for the evaluation of trauma patients with suspected injuries of the thoracic aorta because of its portability, safety, diagnostic accuracy, and potential impact on patient management.
创伤性主动脉破裂（TDA）是一种危及生命的损伤，需要快速诊断和治疗。紧急主动脉造影是目前的标准诊断成像方式，具有侵入性、耗时，且在有多处创伤且血流动力学不稳定的患者中难以实施。我们对疑似TDA的患者进行经食管超声心动图（TEE）检查，以确定这种替代性便携式成像方式的诊断准确性及其对患者管理的影响。
连续32例疑似TDA的创伤患者（平均年龄40±16岁，因暴力减速事故入院，胸部X线显示纵隔>8cm）在急诊室接受了TEE检查。将TEE检查结果与主动脉造影、手术或尸检结果进行比较。观察到两组具有不同超声心动图特征的创伤性主动脉损伤：（1）外膜下TDA（n = 10）和（2）创伤性内膜撕裂（n = 3）。18例患者经主动脉造影证实TEE结果正常。TEE漏诊了一处2mm的内侧撕裂（尸检发现）。TEE诊断外膜下TDA的敏感性和特异性分别为91%和100%。外膜下TDA患者立即接受手术治疗，而内膜主动脉撕裂患者则接受保守治疗。还纳入了18例确诊为累及主动脉峡部的急性主动脉夹层患者（平均年龄57±15岁），以确立该疾病与TDA之间的超声心动图鉴别诊断标准。
由于TEE具有便携性、安全性、诊断准确性以及对患者管理的潜在影响，应将其视为评估疑似胸主动脉损伤的创伤患者的一线成像方式。
