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September 1996

Transmediastinal Gunshot WoundsA Reconsideration of the Role of Aortography

Author Affiliations

From the Department of Surgery, University of Southern California School of Medicine and Los Angeles County+ University of Southern California Medical Center, Los Angeles.

Arch Surg. 1996;131(9):949-953. doi:10.1001/archsurg.1996.01430210047009

Objective:  To evaluate the contribution of aortography in the management of stable patients with transmediastinal gunshot wounds.

Design:  Retrospective review of clinical records.

Setting:  Level I urban trauma center.

Patients:  Forty-three patients with aortic or esophageal gunshot injuries.

Interventions:  Patients who were stable after initial resuscitation underwent aortography followed by esophagography.

Main Outcome Measures:  Hemodynamic status on admission, time devoted to diagnostic workup, surgical (or autopsy) findings, morbidity, and mortality.

Results:  There were 24 esophageal injuries and 20 aortic injuries. Patients with aortic injuries were less often stable for aortography (10% vs 42%; P=.02), and fewer of them survived (15% vs 58%; P=.01). In no patient was the aortic injury initially detected by aortography. Stable patients with esophageal injuries experienced an average 11-hour interval between injury and surgery (nearly 3 hours attributable to aortography).

Conclusion:  Esophageal evaluation should precede aortography in the workup of stable patients with transmediastinal gunshot wounds.Arch Surg. 1996;131:949-953