| Indeterminate CT angiography in blunt thoracic trauma: is CT angiography enough? | |
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MedLine Citation:
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PMID: 17715106 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: The primary objective of our study was to determine whether catheter angiography is needed to exclude aortic and intrathoracic great vessel injury when CT angiography (CTA) findings are indeterminate (mediastinal hematoma without direct evidence of aortic or intrathoracic great vessel injury). The secondary objective was to devise a classification scheme for mediastinal hematomas. MATERIALS AND METHODS: This study is a retrospective analysis of patients presenting with blunt trauma over 4.5 years at a level 1 trauma center. Indeterminate CTA findings in patients with blunt injury were identified through a database search of imaging reports. CTA findings and final outcomes, including catheter angiography and clinicopathologic records, were reviewed independently by blinded observers. RESULTS: One hundred seven patients (age range, 11-88 years) met the inclusion criteria. Seventy-two (age range, 15-88 years) had a reference standard of subsequent catheter angiography, and 35 subjects (age range, 11-87 years) did not undergo catheter angiography and therefore had a reference standard of clinicopathologic review. No subjects with isolated mediastinal hematoma on CTA had aortic or intrathoracic great vessel injury, for a positive predictive value of 0% (95% CI, 0-0.028). Using our proposed classification scheme, we found a direct correlation between the percentage of cases that underwent catheter angiography and hematoma severity. CONCLUSION: When CTA is indeterminate in blunt thoracic trauma, conventional angiography is unlikely to show an aortic or intrathoracic great vessel injury and may be unnecessary. A grading system for mediastinal hematomas could help triage patients to conventional angiography when further imaging is desired. |
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Authors:
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Marla Sammer; Eric Wang; C Craig Blackmore; Thomas R Burdick; William Hollingworth |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: AJR. American journal of roentgenology Volume: 189 ISSN: 1546-3141 ISO Abbreviation: AJR Am J Roentgenol Publication Date: 2007 Sep |
Date Detail:
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Created Date: 2007-08-23 Completed Date: 2007-09-18 Revised Date: 2008-02-15 |
Medline Journal Info:
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Nlm Unique ID: 7708173 Medline TA: AJR Am J Roentgenol Country: United States |
Other Details:
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Languages: eng Pagination: 603-8 Citation Subset: AIM; IM |
Affiliation:
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Department of Radiology, University of Washington, Box 357115, Seattle, WA 98195-7115, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Aged, 80 and over Angiography / methods* Aorta / injuries* Aortography / methods Child Female Heart Injuries / radiography* Hematoma / radiography* Humans Male Middle Aged Reproducibility of Results Risk Assessment / methods Risk Factors Sensitivity and Specificity Thoracic Injuries / radiography* Tomography, X-Ray Computed / methods* Wounds, Nonpenetrating / radiography* |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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