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Mediastinal trauma

Department of Surgery, Division of Trauma and Critical Care, University of Southern California School of Medicine and the Los Angeles County and University of Southern California Medical Center, Los Angeles, CA 90033, USA

Demetrios Demetriades

Department of Surgery, Division of Trauma and Critical Care, University of Southern California School of Medicine and the Los Angeles County and University of Southern California Medical Center, Los Angeles, CA 90033, USA, demetria{at}hsc.usc.edu

The evaluation of mediastinal trauma has undergone some important changes in the last few years. Electrocardiography (ECG) combined with troponin measurements have become the standard of evaluation of suspected blunt cardiac trauma. Spiral computerized tomography (CT) scan has largely replaced angiography for suspected blunt aortic rupture. There is good evidence that with a suspicious mechanism of injury the thoracic aorta should be evaluated irrespective of chest X-ray findings.

In penetrating trauma the introduction of trauma ultrasound in the emergency room has revolutionized the early diagnosis of cardiac tamponade. Most mediastinal gunshot wounds in haemodynamically stable patients can safely be managed non-operatively. Evaluation of the direction of the bullet tract by means of spiral CT scan has replaced angiography and oesophageal studies in about 75% of patients with mediastinal gunshot wounds who are haemodynamically stable.

Key Words: mediastinum • trauma ultrasound • spiral CT scan

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