Imaging the oesophagus after penetrating cervical trauma using water-soluble contrast alone: simple, cost-effective and accurate

Nel, L; Jones, L; Hardcastle, Timothy Craig

doi:10.1136/emj.2008.063958

Cited by 16 publications

(5 citation statements)

References 17 publications

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“…Patients with clinical signs of ADTI or deep surgical emphysema need further investigation with a water‐soluble contrast swallow. This is generally sufficient to rule out any significant digestive tract injury, and reserves endoscopy for the comatose or uncooperative patient with suspected ADTI.…”

Section: Discussionmentioning

confidence: 99%

Correlation between the level of the external wound and the internal injury in penetrating neck injury does not favour an initial zonal management approach

et al. 2020

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Background: Many current protocols for managing penetrating neck injuries (PNIs) still suggest zonal approaches. This study was undertaken to determine the correlation between the zone of the external wound and the level of the internal injury, and to verify whether a 'no-zone' approach to PNI is valid. Methods: Patients admitted with a PNI to a tertiary trauma care centre between January 2011 and May 2018 were identified from a trauma database. Those with confirmed injury to the vascular system or an aerodigestive tract injury (ADTI) were included in the study. The medical records of each patient were reviewed with regard to the zone of the external wound and the level of internal injury, and the findings were compared. Results: In the period under review, 1075 patients were treated for a PNI. Of these, 298 (27⋅7 per cent) had a confirmed vascular injury or ADTI and were included in the cohort. In 176 patients (59⋅1 per cent) the site of the internal injury was in the same zone as the external wound. In a further 70 patients (23⋅5 per cent) there was no correlation between the site of the internal injury and the external wound, and in the remaining 52 patients (17⋅4 per cent) the correlation could not be determined. In this cohort, all clinically assessable patients with significant injuries had either physical signs suggestive of injury or deep surgical emphysema on radiological examination. Conclusion: An approach to PNI based on zones is questionable, and this study supports a no-zone approach based on imaging guided by clinical examination.

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Section: Discussionmentioning

confidence: 99%

Correlation between the level of the external wound and the internal injury in penetrating neck injury does not favour an initial zonal management approach

et al. 2020

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“…It can show multiple signs such as widening of the superior mediastinum >8 cm and/or 25% of the width of the thorax (most common), loss of aortic knob, the obvious double contour of the aorta/abnormalities of the transverse aortic arch (sensitive finding), obliteration of the aortopulmonary window on lateral chest radiography (sensitive finding), massive hemothorax, and right deviation of the nasogastric, endotracheal, or esophageal tubes [8]. Normal vital signs with abnormal findings suggestive of a vascular injury should undergo CT aortography, the gold standard test, to confirm the diagnosis and facilitate operative planning since aortic injury grading is classified based on CT findings [25,34]. Signs on CT include abnormal aortic contour, sudden change in aortic caliber (pseudocoarctation), contained rupture, traumatic pseudoaneurysm, intimal flap, and intraluminal mural thrombus [25].…”

Section: Discussionmentioning

confidence: 99%

“…Signs on CT include abnormal aortic contour, sudden change in aortic caliber (pseudocoarctation), contained rupture, traumatic pseudoaneurysm, intimal flap, and intraluminal mural thrombus [25]. Alternatively, magnetic resonance imaging (MRI) of the thorax, conventional angiography, intravascular ultrasound (IVUS), or transesophageal echocardiogram (TOE) can be used as needed [25,34].…”

Section: Discussionmentioning

confidence: 99%

A Rare Case and Presentation of Traumatic Penetrating Aortic Arch Injury: A Case Report and Literature Review

Alali¹,

Essa²,

Alasheikh³

et al. 2022

Cureus

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A penetrating injury to the thoracic aorta is an extremely rare, life-threatening condition, with a high overall mortality rate. The incidence of a penetrating injury to the aortic arch is unknown because the majority of patients die before receiving adequate treatment due to excessive bleeding. Through a literature review, 23 cases of favorable outcomes were found. We report the first case from the Arab Gulf states. We present the extremely rare case of a 23-year-old male who presented to the emergency department with stable hemodynamics after being stabbed in the left supraclavicular region. The investigation revealed that he suffered from aortic arch transection and contrast extravasation. The patient was rushed to the operating room, where a primary repair was performed through a median sternotomy approach. The patient was discharged on the 14th postoperative day without complications. Penetrating chest trauma (aortic arch injury) is uncommon, and it is typically fatal at the scene or time of injury, even in patients who arrive at the emergency department alive or while undergoing surgery. CT aortography should be performed on patients with normal vital signs but abnormal clinical findings suggestive of a vascular injury. For injuries of types II to IV without concomitant injuries, immediate surgical repair is recommended. Aortic arch penetrating injuries continue to be extremely lethal. Emergency surgical repair remains the standard of care and is associated with high morbidity and mortality rates. However, managing such uncommon injuries remains a formidable challenge. We encourage additional studies.

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“…Our retrospective study, however, is in agreement with more recent studies concluding that water-soluble contrast esophogram alone is highly sensitive in evaluating esophageal injury or leaks. For example, Nel et al [9] showed a sensitivity of 100 %, specificity of 99.8 %, and negative predictive value of 99.6 % for esophageal injury/leak using only water-soluble contrast in penetrating cervical injuries. This is in line with our findings that water-soluble esophograms have sensitivity and negative predictive value of 100 %.…”

Section: Discussionmentioning

confidence: 99%

Follow-up barium study after a negative water-soluble contrast examination for suspected esophageal leak: is it necessary?

et al. 2015

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The purpose of this study was to determine the value of follow-up barium esophogram in diagnosing esophageal injury or leak if the initial water-soluble contrast examination of the esophagus is normal. An institutional review board (IRB)-approved retrospective review of all pediatric patients less than 18 years old referred to the radiology department for evaluation of esophageal injury or leak was performed for a 9-year period from 2005 to 2014. The majority of patients had unexplained pneumomediastinum, chest trauma (gunshot or puncture wound), or foreign body ingestion as the reason for the referral. Forty-nine patients (age range 10 days to 17 years) underwent an initial water-soluble esophogram immediately followed by a barium esophogram. Forty-six studies were negative on both water-soluble contrast and barium studies. Two studies were both positive on the initial water-soluble contrast and subsequent barium studies. A single study showed the esophageal leak only in the water-soluble study, with the follow-up barium exam being normal. The result of this study indicates that a single-contrast water-soluble esophogram alone is sensitive in the diagnosis of esophageal injury or leak. It has a 100 % sensitivity and negative predictive value. A follow-up barium esophogram only increases the study time and radiation dose to the patient.

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Imaging the oesophagus after penetrating cervical trauma using water-soluble contrast alone: simple, cost-effective and accurate

Cited by 16 publications

References 17 publications

Correlation between the level of the external wound and the internal injury in penetrating neck injury does not favour an initial zonal management approach

Correlation between the level of the external wound and the internal injury in penetrating neck injury does not favour an initial zonal management approach

A Rare Case and Presentation of Traumatic Penetrating Aortic Arch Injury: A Case Report and Literature Review

Follow-up barium study after a negative water-soluble contrast examination for suspected esophageal leak: is it necessary?

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