Further experience with transesophageal echocardiography in the evaluation of thoracic aortic injury

This prospective study sought to further define the role of transesophageal echocardiography (TEE) in diagnosing thoracic aortic injury. We performed TEE, aortography, or both on 160 consecutive patients suspected of having blunt thoracic aortic injury: TEE correctly identified 14 aortic injuries, of which five were confirmed by aortography, seven at thoracotomy, and two at autopsy. The TEE results were suggestive of but not diagnostic for injury in two additional patients with proven aortic injury, and TEE was otherwise 100% sensitive and specific for aortic injury. Aortograms yielded one false positive result and four false negative results, for a sensitivity of 73% and a specificity of 99%. We conclude that TEE is a rapid, safe, and accurate bedside method for evaluating the heart and thoracic aorta for blunt trauma. Negative or positive TEE results obviate the need for aortography. We recommend that aortography be used when TEE results are equivocal, when TEE is not tolerated or contraindicated, or when other suspected vascular injuries require evaluation by arteriography.