[Diagnostic value of transesophageal echocardiography in traumatic rupture of the thoracic aorta]

Traumatic rupture of the aorta (TRA) usually occurs at the isthmus. It is rapidly lethal without early surgery and, therefore, diagnosis must not be delayed. The reference diagnostic investigation is aortography but it is invasive in a patient with multiple trauma whose haemodynamic status is often precarious. Transoesophageal echocardiography, a non-invasive investigation which can be undertaken rapidly at the bedside has been proposed recently for the diagnosis of this condition because it gives excellent views of the aortic isthmus. The authors report their experience of transoesophageal echocardiography in 3 victims of severe road traffic accidents with thoracic trauma and who were operated for traumatic rupture of the aorta. Echocardiographic diagnosis of TRA is based on the recording of the association of a thick and mobile intraluminal echo corresponding to the torn intima and media and localised dilatation of the aorta, the wall of which is reduced to the adventitia under tension. On Doppler colour flow mapping the velocities are similar on both sides of the tear but turbulence at the site of rupture may give rise to aliasing. It is important to recognise the echocardiographic features of TRA to differentiate it from dissection of the aorta. Transoesophageal echocardiography also allows diagnosis of any associated traumatic cardiovascular lesions. Its limitations are due to the inability to visualise the proximal portion of the transverse aorta and the supra aortic vessels. Aortography remains essential when a lesion of these vessels is suspected and when the echocardiographic features of the aorta are atypical.