Traumatic aortic ruptures diagnosed by transesophageal echocardiography

The aim of this study was to determine the diagnostic efficiency of transesophageal echocardiography (TEE) in isthmic aortic ruptures and to describe the echocardiographic Doppler anomalies. TEE was performed prospectively for 18 months in 33 patients with serious polytraumas requiring intensive car...

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Bibliographic Details
Published in:	Journal of the American Society of Echocardiography Vol. 9; no. 5; p. 657
Main Authors:	Berenfeld, A, Barraud, P, Lusson, J R, Haziza, F, Papouin, G, Cassagnes, J
Format:	Journal Article
Language:	English
Published:	United States 01-09-1996
Subjects:	Adolescent Adult Aged Aneurysm, Dissecting - diagnostic imaging Aorta - injuries Aortic Aneurysm - diagnostic imaging Aortic Rupture - diagnostic imaging Echocardiography, Doppler Echocardiography, Transesophageal - methods Hematoma - diagnostic imaging Humans Middle Aged Multiple Trauma Prospective Studies Thoracic Injuries - diagnostic imaging
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Summary:	The aim of this study was to determine the diagnostic efficiency of transesophageal echocardiography (TEE) in isthmic aortic ruptures and to describe the echocardiographic Doppler anomalies. TEE was performed prospectively for 18 months in 33 patients with serious polytraumas requiring intensive care. The average age was 40.75 years (range, 17 to 78 years). Single or biplanar TEE was used. In three patients with aortic transection, echocardiography showed an intimal flap thicker than that of dissections. The flaps were torn and retracted on the free edge. It was difficult to distinguish the periaortic hematoma. Doppler imaging showed turbulent flows in several places around the aorta. These flows were especially visible at the beginning of the intimal flap. They were visible on M-mode color imaging during systole and diastole. During diastole, a large color flow was observed in the middle of the aortic lumen. It was turbulent in some places and mimicked the systolic filling of the aorta. These flows create the characteristic "to and fro sign" spectrum of Doppler imaging, usually seen in peripheral false arterial aneurysms. TEE findings were confirmed in two cases by surgery and in one case by aortography. TEE seems to be an effective means of detecting isthmic rupture, with the diagnosis resting on the data obtained from echocardiography and Doppler imaging. A suspected isthmic disruption should be assessed by an emergency TEE and aortography used only for uncertain or complex cases.
ISSN:	0894-7317
DOI:	10.1016/S0894-7317(96)90061-9