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Multiplane transesophageal echocardiography in traumatic aortic dissection: a case report
W B Liao1, M J Bullard, S J Liaw
1Department of Primary Care and Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan, R.O.C.
Changgeng Yi Xue Za Zhi
|December 1, 1995
Summary
Multiplane transesophageal echocardiogram (MTE) diagnosed a traumatic aortic dissection missed by CT scans. While the patient succumbed to abdominal injuries, MTE enabled effective monitoring of the dissection
Area of Science:
- Cardiology
- Trauma Surgery
- Diagnostic Imaging
Background:
- Traumatic aortic dissection is a rare but life-threatening injury often resulting from high-energy impacts.
- Computed tomography (CT) is the standard imaging modality, but can sometimes miss subtle aortic injuries.
Observation:
- A 23-year-old male sustained blunt chest trauma in a traffic accident, presenting with a widened mediastinum on chest X-ray.
- Initial CT scan did not reveal aortic dissection, but suspicion remained due to the injury mechanism.
Findings:
- Multiplane transesophageal echocardiogram (MTE) successfully diagnosed a small aortic dissection, which was not evident on CT.
- MTE allowed for serial monitoring of the dissection's progression (4 cm) and flow dynamics within the false lumen.
- The patient developed intra-abdominal complications (liver laceration, jejunal perforation, abscess) leading to sepsis and multi-organ failure, ultimately resulting in death.
Implications:
- MTE is a valuable tool for diagnosing traumatic aortic dissections, especially when CT is equivocal.
- This case highlights the utility of MTE in monitoring dissection progression and guiding management in critically ill trauma patients.
- Despite the fatal outcome from abdominal injuries, MTE provided crucial information for prognostication and treatment planning of the aortic injury.