The succes story of transesophageal echocardiography (TEE) is impressive.

The succes story of transesophageal echocardiography (TEE) is impressive. In just a scarcely any years, the technique has become an integral part of mostly echocardiography laboratories. The ability to use high oftenness transducers directed at structures located at cease range and without any interference from either the lung or chest wall has inferenceed in images with exquisite detail. Furthermore, adequate echocardiographic images are obtainable in almost all patients. lately Matsuzaki et al[1] nicely summarized the advantages of TEE through the whole extent of transthoracic echocardiography (TTE). It has proven far superior to TTE in the diagnosis of bacterial endocarditis, and the assessment of prosthetic valves, atrial septal flaws atrial thrombi, and atrial "smoke" Additionally, it provides certain information not readily available by dint of the transthoracic approach, such as information about the diagnosis of descending thoracic aortic aneurysms,[1] imaging of coronary arteries, intraoperative and perioperative monitoring,[1] aortic plaques,[2] and pulmonary embolism,[3] with a high measure of sensitivity and specificity.

Several articles have adviseed that TEE could likewise be a gorgeous technique to study normal and pathologic piles of the mediastinum.[4-11] It has been base to be as sensitive as, granting somewhat less specific than, MRI[4,5] and CT[5] in diagnosing thoracic aortic dissection. It is invaluable and far superior to TTE in detecting the underlying mechanisms of postoperative cardiac tamponade.[6,7] In regard to neoplastic disease of the mediastinum, it is superior to TTE in differentiating nonvascular from vascular lesions, and in assessing pericardial infiltration, superior vena cava and pulmonic vein melt and the infiltration or compression of other vascular and cardiac structures[8-10] Furthermore, it can be used to assess the results of these masses on left ventricular function.[11] A newly come study by Seward et al[12] supports an till doomsday greater potential for TEE assesment of mediastinal pathology in the coming events as multiplane/rotational probes develop.

In this issue of Chest, Le Bret et al (see page 373) examine the potential value of TEE in diagnosing traumatic mediastinal hematomas. They inquiry two groups of patients: assign places to 1, consisting of 22 patients with inexorable chest trauma, and group 2 (control group) consisting of 20 patients diagnosed with brain death from various causes, yet in whom no chest trauma existed. All patients underwent a single plane transesophageal echocardiogram. Mediastinal hematoma was felt to be instant based on the findings obtained by way of either chest CT or thoracic surgery or the two The authors found that the following three TEE signs could be used to diagnose mediastinal hematoma: (1) greater than 3-mm distance between the TEE probe and the aortic wall; (2) a double contour for the aortic wall; and (3) visualization of ultrasound signals between the aortic wall and visceral pleura. The first of these signs was seen in all patients with mediastinal hematoma and in simply one without it. The follows of the study by Le Bret et al demonstrate that TEE is a highly sensitive and specific technique for diagnosing mediastinal hematoma, a condition that, owing to its high association with utensil rupture, poses a potentially serious threat to patients with chest trauma. This and other studies[13-15] would allude to that the use of TEE in patients with chest trauma is safe and effective.

Should TEE then be used in all trauma patients? At this point, I would say no. Le Bret's data proceed from a population with real high risk for mediastinal hematomas; a large number of patients with les risk of this entity will ne to be studied to confirm the safety, sensitivity, and specificity of the three TEE signs described by dint of LeBret et al. Furthermore, rapid advances in catheter-mounted ultrasound crystal technology[16] could eventually struggle with, complement, or substitute TEE for the evaluation of trauma-related mediastinal pathologic condition.

REFERENCES

[1] Matsuzaki M Toma Y Kusukawa R Clinical applications of transesophageal echocardiography. Circulation 1990; 82:709-22

[2] Blackshear JL Jaahangir A, Oldenburg WA, Safford RE Digital embolization from plaque-related thrombus in the thoracic aorta: identification with transesophageal echocardiography and resolution with warfarin therapy. Mayo Clin Proc 1993; 68:268-72

[3] Popovic AD, Milovanovic B Neskovic A, Pavlovski K Putnikovic B Hadzagic I. Detection of massive pulmonary embolism by the agency of transesophageal echocardiography. Cardiology 1992; 80:94-9

[4] Nienaber CA, Spielmann RP von Kodolitsch Y Siglow V Piepho A, Jaup T et al. Diagnosis of thoracic aortic dissection: magnetic resonance imaging versus transesophageal echocardiography. Circulation 1992; 85:434-47

[5] Nienaber CA, von Kodolitsch Y Nicolas V Siglow V Piepho A, Brockhoff C et al. The diagnosis of thoracic aortic dissection by dint of noninvasive imaging procedures. N Engl J M 1993; 328:1-9

...