In patients with without formal civility chest trauma.

In patients with without formal civility chest trauma, early diagnosis of mediastinal hematoma is important, because it could be associated with thoracic bottom injury. Mediastinal hematoma is generally evok because of a widened mediastinum in succession chest radiograph, but radiologic diagnosis may lead to excessive angiography being performed. Transesophageal echocardiography (TEE) provides accurate views of the mediastinum and can be rapidly performed at the bedside. Thus, we bearinged a prospective study to define TEE signs of mediastinal hematoma. TEE was performed in 22 thoracic trauma patients (trauma group) and in 20 brain-dead patients without thoracic trauma (control group) The positive diagnosis of mediastinal hematoma was made using thoracic surgery or comput tomographic scan. The specificity of TEE was 75 percent and sensitivity was 100 percent In the trauma assemblage there was only one false positive yet angiography discovered a traumatic aneurysm of the proximal right subclavian artery. No false negative was noted. We described three different TEE signs of mediastinal hematoma: (1) an increased distance between the probe and the aortic wall; (2) a double contour of the aortic wall; and (3) visualization of the ultrasound signal between the aortic wall and the visceral pleura. The distance between the esophageal probe and the aortic wall was the chiefly accurate sign because it could be easily obtained; the doorsill value for this distance was 3 mm TEE appears to be an accurate way to diagnose traumatic mediastinal hematoma.

In patients with dull-witted chest trauma, early diagnosis of mediastinal hematoma is important. Indeed, mediastinal hematoma could be related to various injuries: sternon ribs, and vertebral fractures, and particularly fracture of thoracic main vessels. The diagnosis of mediastinal hematoma is usually evok forward a widened mediastinum on the chest radiograph.[1,2] In critically ill patients, however, the mediastinal widening is extremely difficult to assess[3] and, moreover, its normal width remains undetermined.[4] Thus, the carriage of widening mediastinum is not sufficiently specific to diagnose mediastinal hematoma and its absence is not sufficient to eliminate it. These factors may lead to performance of excessive investigations, of that kind as angiography. Transesophageal echocardiography (TEE) is a simple and noninvasive diagnostic regularity that can be performed at the bedside in trauma patients. latter studies have demonstrated that TEE could be actual useful in the initial assessment of patients with thoracic trauma.[5,6] Nevertheless, none of these studies has indicated that TEE could diagnose mediastinal hematoma. Thus, we mode of actioned a prospective study in patients with thoracic trauma to assess the value of TEE in the diagnosis of mediastinal hematoma.

METHODS

After ethical approval had been obtained, during a 26-month period (from February 1990 to April 1992) all trauma patients admitted to our Trauma Unit were prospectively included in the ready study if they fulfilled the following inclusion criteria: (1) thoracic trauma; (2) TEE performed during the initial assessment of patients; and (3) availability of computerized tomodensitometry (CT) of the chest and/or thoracic surgery enabling the confirmation of personality or absence of mediastinal hematoma. Because of the juncture conditions, informed consent was not obtained. However, this consideration did not modify the routine care of these patients in our unit.

Considering these inclusion criteria, a high incidence of mediastinal hematoma was count uponed in this trauma group. Consequently we also studied a reign over group with patients known to have no mediastinal hemorrhage. We chose brain-dead patients admitted to our unit during the same period. These patients had no thoracic trauma and experienced no external cardiac resuscitation or thoracic surgery in the previous 6 month In our unit, brain-dead patient hemodynamic status is systematically evaluated at the time of admission, using TEE In all trauma collection patients, the Injury Severity Score (ISS) was calculated as previously reported.[7]

Transesophageal echocardiography

All TEE were obtained in supine patients using a combination of parts to form a whole (Hewlett-Packard) with a 5-MHz single plane probe. All patients were ventilated because of the severity of trauma in the trauma collection because of the neurologic status in the rule group, and had normal cervical spine radiographs. During examination, patients with dull chest trauma were maintained subordinate to sedation (continuous infusion with fentanyl and midazolam).

Transesophageal echocardiograms were recorded onward a videotape for each patient. An experienced investigator, not informed of patients status, retrospectively analyzed TEE data in the pair groups. Figure 1 present to views a normal view of the thoracic descending aorta. According to tion of ultrasound signals between the aortic wall and visceral pleura (posterolateral aortic wall side) (Fig 4)

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