Traumatic subarachnoid hemorrhage visualized with transesophageal echocardiography

Computed tomography (CT) is the current standard for the early diagnosis of traumatic subarachnoid hemorrhage (tSAH). It is, however, not feasible when a patient is hemodynamically unstable. We report a novel method of visualizing tSAH with transesophageal echocardiography (TEE). The spinal cord was visualized through the intervertebral disc with the transducer directed posteriorly in the esophagus. TEE findings of the spinal cord in three patients with tSAH were compared with those of 19 patients without it. In the former, fibrin-like mobile images were present, the ratio of diameter of spinal cord to internal diameter of spinal canal was significantly larger (0.59 +/- 0.07 vs. 0.45 +/- 0.04, p = 0.0070) and the pia mater was significantly thicker (1.41 +/- 0.12 mm vs. 0.66 +/- 0.15 mm, p = 0.0001). Our findings suggest that TEE may be an alternative way of diagnosing early tSAH at bedside in patients in which CT is not feasible.