Controversy of transesophageal echocardiography for diagnosis of traumatic aortic injury.

Abstract

Controversy of Transesophageal Echocardiography for Diagnosis of Traumatic Aortic Injury To the Editor I enjoyed the paper of traumatic aortic rapture reported by Ikeda et al.' The utilization of transesophageal echocardiography (TEE) for blunt aortic injury is acknowledged to be controversial, although though Dr. Ikeda concluded TEE could be effective tool to diagnose of blunt aortic injury. Unlike aortogram, TEE is non-invasive, requires no contrast media, and can be performed at bedside in emergency room within 15-20 minutes. TEE is known to be effective in detecting the injury involving the proximal ascending aorta and/or the discending aorta. Blunt aortic injury occurs most frequently at the isthmus which can be easily diagnosed by TEE. A study demonstrated routine TEE to the victims of chest trauma could detect aortic injury in patients with or without mediastinum widening on chest X-ray. 2 Due to the air-filled space and the complexity of the aortic branches, the ascending aorta and aortic arch are known to be blind spots of TEE. A prospective trial of TEE in 29 cases blunt chest trauma yielded unfavorable results, with a sensitivity of 57% and specificity of 91%, while aortography yielded with sensitivity of 89% and specificity of 100%. 3 Another larger prospective study of TEE for blunt aortic injury demonstrated similar results (Sensitivity 63%, Specificity 84%, and 3 falsenegatives) . Although TEE has several advantage for diagnosis of aortic injury, TEE is not more definite than aortography. TEE may overlook an aoritc lesion if it is used as the sole diagnostic tool in the evaluation of patients with chest trauma.