Chest
Volume 109, Issue 1, January 1996, Pages 73-77
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Clinical Investigations: Cardiology/Imaging
The Usefulness of Transesophageal Echocardiography in Diagnosing Cardiac Contusions

https://doi.org/10.1378/chest.109.1.73Get rights and content

Objectives

To assess the usefulness of transesophageal echocardiography in diagnosing cardiac contusions in patients with blunt trauma.

Background

For more than a decade, noninvasive tests, including ECGs, cardiac enzymes, nuclear studies, and transthoracic echocardiography have been utilized in an attempt to identify trauma patients with cardiac injuries. These tests have been imperfect in identifying the patients at high risk for mortality.

Methods

We retrospectively reviewed the charts in 22 patients with transesophageal echocardiographically diagnosed cardiac contusions noting age, race, sex, transthoracic echocardiographic examinations, study quality, and outcome. We also noted the Injury Severity Score, which is a measure of the severity of illness in trauma patients. Higher scores correlate more severe injury and higher mortality. We defined cardiac contusions as presence of wall motion abnormality, including either or both ventricles, in the absence of transmural myocardial infarction on ECG following nonpenetrating chest trauma.

Results

Over a 30-month period, 81 transesophageal echocardiographic examinations were performed on trauma patients. Among this group, 22 patients were diagnosed as having cardiac contusions. There were 15 patients with right ventricular contusions, 7 patients with left ventricular contusions, and 2 patients with both ventricles involved. We compared this group with all ICU trauma patients admitted to the hospital during this time period. Overall, the contusion patients had an average Injury Severity Score of 27 and a mortality of 27% compared with the overall trauma group with an Injury Severity Score of 33 and a corresponding mortality of 9% (p<0.001). Corresponding ECGs were nondiagnostic in 73% of patients with cardiac contusion. There were no complications related to the transesophageal examinations.

Conclusions

Transesophageal echocardiographically diagnosed cardiac contusion in trauma patients carries a high mortality rate. Transesophageal examinations are safe and provide excellent quality images where transthoracic examinations were inadequate. Right ventricular contusions are approximately twice as common as left ventricular contusions.

Section snippets

MATERIALS AND METHODS

We retrospectively reviewed the usefulness of transesophageal echocardiography in diagnosing cardiac contusions at Cooper Hospital/University Medical Center. Our hospital is a level 1 trauma center with approximately 1,770 admissions each year, of which approximately 30% have sustained trauma to the chest. During the period from July 1990 to September 1992, 81 transesophageal echocardiograms were performed on patients treated in the trauma ICU or in the trauma admitting area of the emergency

RESULTS

Table 1 shows the demographic profile for each patient, including age, race, and sex. The average age was 41 years, with 82% white and 86% men. Among these patients, 55% were younger than 40 years old, and 68% were younger than 55 years old.

At our institution, if cardiac contusion is considered, a transthoracic echocardiogram is ordered. If windows are obtainable on the chest wall, this study is performed. If the study is a technically limited study, then a transesophageal echocardiogram is

DISCUSSION

It has long been recognized that approximately 15% of victims of fatal chest trauma have myocardial contusions demonstrated at autopsy.22 Despite extensive clinical experience and experimental work, there is still controversy about definitive criteria for this clinical diagnosis. There is a need for a readily available “noninvasive,” sensitive, and specific diagnostic test that can prognosticate this condition. We undertook this study to determine if transesophageal echocardiography may fulfill

ACKNOWLEDGMENTS

Acknowledgments go to Christine M. Dalton for her secretarial assistance in preparing this manuscript and Michele Weiss, RDCS, for her technical assistance.

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