Computed Tomography Angiography is the Definitive Vascular Imaging Modality for Penetrating Neck Injury: A South African Experience (original) (raw)
Related papers
South African Journal of Radiology, 2014
Background: Penetrating neck trauma is commonly encountered in South African trauma units, and is associated with high mortality and morbidity rates. The imaging protocol for stable patients with penetrating neck trauma remains controversial. There is only sparse data validating the use of computed tomography angiography (CTA) in the evaluation of penetrating neck trauma in South Africa.Objectives: To assess the sensitivity and specificity of CTA versus digital subtraction angiography (DSA) in detecting arterial injury and secondarily evaluate the ability of CT to assess non-arterial injury.Method: Using hospital and radiology databases, 23 patients were identified who had undergone both CTA and DSA for penetrating neck trauma. The data was retrospectively anonymised and randomised. A radiologist experienced in the interpretation of both trauma CTA and DSA re-reported all the imaging and the findings were compared and analysed.Results: Twenty-four arterial injuries were detected. Th...
CT Angiography in Penetrating Neck Trauma Reduces the Need for Operative Neck Exploration
The American Surgeon, 2005
The evaluation of penetrating neck injury has evolved dramatically from mandatory operative exploration of Zone II injuries that penetrate the platysma to selective management based on physical examination and adjunctive studies. More recently, CT angiography has emerged as an efficient, noninvasive method of evaluating penetrating neck injury. We retrospectively reviewed our experience over 10 years with the management of penetrating neck injury. One hundred thirty cases were reviewed with 34 undergoing CT angiogram (Group CTA) and 96 with no CT angiogram (Group nCTA). Group CTA had significantly fewer neck explorations, 1 (3%) versus 32 (33%), P < 0.001. Negative explorations were significantly higher in nCTA as well, with a rate of 22 per cent versus 0 in CTA ( P < 0.01). The use of angiogram and esophagram was also significantly lower in CTA versus nCTA ( P = 0.02 and P = 0.04). Of the 34 patients in CTA, 4 (12%) also underwent angiography and 4 (12%) received a contrast e...
Evaluation of Penetrating Injuries of the Neck: Prospective Study of 223 Patients
World Journal of Surgery, 1997
The objective of this study was to assess the role of clinical examination, angiography, color flow Doppler imaging, and other diagnostic tests in identifying injuries to the vascular or aerodigestive structures in patients with penetrating injuries to the neck. A prospective study was made of patients with penetrating neck injuries. All patients had a careful physical examination according to a written protocol. Stable patients underwent routine four-vessel angiography and color flow Doppler imaging. Esophagography and endoscopy were performed for proximity injuries. The sensitivity, specificity, and predictive values of physical examination, color flow Doppler studies, and other diagnostic tests were assessed during the evaluation of vascular and aerodigestive tract structures in the neck. Altogether 223 patients were entered in the study. After physical examination 176 patients underwent angiography and 99 of them underwent color flow Doppler imaging. Angiographic abnormalities were seen in 34 patients for an incidence of 19.3%, but only 14 (8.0%) required treatment. Color flow Doppler imaging was performed on 99 patients with a sensitivity of 91.7%, specificity 100%, positive predictive value (PPV) 100%, and negative predictive value (NPV) 99%. These values were all 100% when only injuries requiring treatment were considered. None of the 160 patients without clinical signs of vascular injury had serious vascular trauma requiring treatment (NPV 100%), although angiography in 127 showed 11 vascular lesions not requiring treatment. "Hard" signs on clinical examination (large expanding hematomas, severe active bleeding, shock not responding to fluids, diminished radial pulse, bruit) reliably predicted major vascular trauma requiring treatment. Among 34 of the 223 total patients (15.2%) admitted with "soft" signs, 8 had angiographically detected injuries, but only one required treatment. An esophagogram was performed on 98 patients because of proximity injuries (49 patients) or suspicious clinical signs (49 patients), and two of them showed esophageal perforations. None of the 167 patients without clinical signs of esophageal trauma had an esophageal injury requiring treatment. It was concluded that physical examination is reliable for identifying those patients with penetrating injuries of the neck who require vascular or esophageal diagnostic studies. Color flow Doppler imaging is a dependable alternative to angiography. An algorithm for the initial assessment of neck injuries is suggested.
Penetrating injuries of the neck and the increasing role of CTA
Emergency Radiology, 2004
Vascular injuries of the neck are most frequently the result of penetrating trauma. Diagnostic evaluation of hemodynamically stable patients who have suffered penetrating neck wounds is challenging and remains controversial. In order to reduce morbidity and mortality, prompt diagnosis and subsequent treatment of these injuries is critical. Traditionally, these patients undergo direct contrast angiography. However, this technique has limitations including its invasive nature and potential complications. The use of routine screening angiography has also been questioned because of the low rate of positive examinations. More recently, helical and multislice CT angiography (CTA) has emerged as a fast, minimally invasive accurate study to evaluate penetrating neck injuries. CTA is not operator-dependent and the results can be reproduced easily by using established technical parameters. It is readily available in most centers and allows the simultaneous evaluation of the extravascular soft tissues and bones.
Helical computed tomographic angiography in penetrating neck trauma
Emergency Radiology, 1997
The purpose of this study was to evaluate the ability of helical computed tomographic angiography (HCTA) to detect vascular injury in penetrating neck trauma. Thirty-five patients (30 gunshot wounds and 5 stab wounds) were studied prospectively with HCTA. Scans were performed with a 5-mm slice thickness at a 1:1 pitch after injection of 90 ml of nonionic contrast medium (30-second delay) at 3 ml/sec. Results were compared with those for angiography (29), surgery (3), ultrasound (2), and local inspection (1). HCTA correctly revealed 19 normal and 10 abnormal studies. In 8 cases, HCTA revealed irregular vessel margins (3), contrast extravasation (2), lack of vascular enhancement (1), and caliber changes (2). In 2 patients, HCTA revealed indirect signs of injury only. In 6 cases, HCTA findings did not correlate with angiography. HCTA detects both direct and indirect signs of vascular injury. Although indirect findings are more sensitive, the direct evaluation of vessels increases the specificity and has a high negative predictive value.
Evaluation of the use of tomography in penetrating neck trauma
Revista do Colegio Brasileiro de Cirurgioes, 2015
the study has the intention of evaluate the accuracy of computed tomography for the diagnosis of cervical lesions on penetrating neck trauma and also identify the most frequent mechanisms of trauma. Most injured structures, determine the age range and the most prevalent sex. observational descriptive retrospective study executed by the systematic retrospective review of medical records of all patients victims of penetrating neck trauma that went through surgery and CT scans, admitted into Hospital do Trabalhador, between January 2009 and December 2013. the final sample was of 30 patients, 96.7% of the male sex, the median age was of 28 years old. Most patients suffered injuries by gun (56.7%) and 33,3% suffered stab wounds. The most stricken area of the neck was Zone II (77.8%) and the left side (55.2%). Regarding the structures injured, the CT showed 6.7% lesions on airways but the surgery showed 40% of damaged, with a value of p=0.002. As to damages of the esophagus and pharynx th...
CT Angiography of the Carotid Arteries in Trauma to the Neck
European Journal of Vascular and Endovascular Surgery, 2001
Objectives: serious vascular injuries to the neck may be asymptomatic or masked by other life-threatening conditions. Angiography, the "gold standard" vascular imaging modality, is an invasive procedure. Moreover, it is time-consuming and thus may delay a needed vascular intervention. The results of screening angiography are negative in more than 80% of cases. Therefore other less invasive and faster screening tests, such as the Doppler ultrasound and magnetic resonance angiography, have been tested. This retrospective study was done to evaluate the use of CT angiography (CTA) in suspected vascular injuries of the neck.
Diagnostic performance of CT angiography in neck vessel trauma: systematic review and meta-analysis
Emergency Radiology, 2016
This study was conducted in order to define the diagnostic performance of CT angiography for vascular injuries compared with angiography in patients with neck trauma. CT angiography is the cornerstone of diagnosis for hemodynamically stable patients with wounds suspicious of vascular trauma in the limbs, chest, or abdomen. Available evidence for the use of CT angiography in neck vascular trauma comes from small case series and few randomized controlled trials, and high-quality information does not exist regarding its performance. A protocol using the recommendations of the Cochrane Collaboration was designed. A systematic search of diagnostic studies without limits on language or time was carried out to December 2014. Studies including patients with neck trauma with retrospective or prospective data collection that assessed CT angiography compared with other methods were selected. Methodological quality was assessed using the QUADAS-2 tool. A hierarchical model ROC curve and a bivariate random effects model were used for the pooled analysis. Sixteen studies were selected and reviewed, and nine studies with 693 patients were included in this review. The overall sensitivity was 97 % (95 % CI 0.77-1.00; I 2 = 65.7 % (41.4-90.0)), while the overall specificity was 99 % (95 % CI 0.93-1.00; I 2 = 0). The hierarchic ROC curve showed an area under the curve of 0.99. Publication bias was not identified in this study. CT angiography can be stated as the gold standard for diagnosing vascular injuries in hemodynamically stable patients with neck trauma.
Penetrating neck injuries: helical CT angiography for initial evaluation
Radiology
PURPOSE: To report an experience with helical computed tomographic (CT) angiography as the initial procedure to rule out arterial lesions caused by penetrating neck injuries. MATERIALS AND METHODS: During 27 months, 175 patients were referred for helical CT angiography of the neck because of clinical suspicion of arterial injuries. The protocol included a 100-mL bolus of nonionic contrast material injected at 4.5 mL/sec, with 11-second scanning delay, 3-mm collimation, and pitch of 1.3-2.0. CT images were interpreted prospectively by the emergency radiologist, and two radiologists retrospectively interpreted studies with consensus. Outcome was determined with examination of patients and their charts. The sensitivity, specificity, and positive and negative predictive values were calculated. RESULTS: Studies in two patients were considered inadequate for diagnosis; these patients were referred for conventional arteriography and had normal findings. In 27 patients (15.6%), arterial lesions were detected. One patient had two arterial injuries. Lesions demonstrated with helical CT angiography were arterial occlusion (n ϭ 14), pseudoaneurysm (n ϭ 8), pseudoaneurysm and arteriovenous fistulae (n ϭ 4), and partial thrombosis (n ϭ 2). The remaining 146 patients had normal arteries. On the basis of these findings, patients were treated with surgery (n ϭ 21), endovascular intervention (n ϭ 7), and observation alone (n ϭ 146). CONCLUSION: Results indicate that helical CT angiography can be used as the initial method for evaluation in patients with possible arterial injuries of the neck.