| Helical computed tomographic scan in the evaluation of mediastinal gunshot wounds. | |
| | |
MedLine Citation:
|
PMID: 11038087 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
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. |
| | |
Authors:
|
D E Hanpeter; D Demetriades; J A Asensio; T V Berne; G Velmahos; J Murray |
Related Documents
:
|
11717067 - Assessment of the clinical utility of the rim and comet-tail signs in differentiating u... 8816517 - Evaluation of thoracic aortic disease with the use of helical ct and multiplanar recons... 12076907 - Detection of hepatocellular carcinoma: value of adding delayed phase imaging to dual-ph... 10887247 - Stair-step artifacts with single versus multiple detector-row helical ct. 21990537 - Iatrogenic dissection during neurointerventional procedures: a retrospective analysis. 19411027 - The clinical impact of magnetic resonance imaging in diagnosing focal hepatic lesions a... |
Publication Detail:
|
Type: Journal Article |
Journal Detail:
|
Title: The Journal of trauma Volume: 49 ISSN: 0022-5282 ISO Abbreviation: J Trauma Publication Date: 2000 Oct |
Date Detail:
|
Created Date: 2000-10-20 Completed Date: 2000-11-02 Revised Date: 2004-11-17 |
Medline Journal Info:
|
Nlm Unique ID: 0376373 Medline TA: J Trauma Country: UNITED STATES |
Other Details:
|
Languages: eng Pagination: 689-94; discussion 694-5 Citation Subset: AIM; IM |
Affiliation:
|
Department of Surgery, Los Angeles County--University of Southern California, USA. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adolescent Adult Female Humans Male Mediastinum / injuries* Prospective Studies Thoracic Injuries / radiography*, surgery Tomography, X-Ray Computed* Triage / methods* Wounds, Gunshot / radiography*, surgery |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Accuracy of administrative data in trauma: splenic injuries as an example.
Next Document: Blunt and penetrating trauma of the thoracic aorta and aortic arch branches: an autopsy study.