Rapid diagnosis of thoracic aortic transection using intravenous digital subtraction angiography

Article Abstract:

One frequently lethal result of blunt trauma is rupture of the thoracic aorta, a segment of the aorta, which is the main vessel carrying blood from the heart to the body. This complication is one of the most frequent causes of death at the scene of motor vehicle accidents, and its incidence has increased in recent years. Due to better pre-hospital care, more patients survive to reach the hospital, but hospital mortality remains high. One cause of the high death rate is the length of time required for conventional biplane angiography, a method of viewing the blood vessels under X-ray, to evaluate the thoracic aorta. It is possible that another angiographic approach, intravenous digital subtraction angiography (IVDSA), could enhance the speed of this screening process. This was evaluated by studying 50 patients who underwent IVDSA and conventional biplane angiography. IVDSA required an average of 18 minutes; in five patients, the thoracic aorta was seen to be transected (cut), and the patients were immediately taken to the operating room. The diagnostic phase for these patients required 16 minutes, on average. IVDSA results were either not of acceptable quality, or appeared normal, for the remaining 45 patients. These patients underwent conventional biplane angiography, which required an additional 71 minutes. Two patients with aortic transections were identified in this group. Reasons for the poor-quality IVDSA obtained are discussed. Some researchers have suggested that CT (computerized tomography) or MRI (magnetic resonance imaging) be used for the diagnosis of thoracic aorta rupture. These suggestions are discussed and discarded. IVDSA offers several advantages over other imaging techniques, including IADSA (intra-arterial DSA), because it may be performed so quickly. The approaches taken to improve the method's image quality are outlined. Presently, the main use for IVDSA is as a screening tool to identify, but not to exclude, aortic injury. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Surgery, Angiography, Blunt trauma, Aorta, Thoracic, Thoracic aorta

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Limited value of technetium 99m-labeled red cell scintigraphy in localization of lower gastrointestinal bleeding

Article Abstract:

A major problem in treating patients with gastrointestinal (digestive tract) bleeding is locating the source of the bleeding. A method that is used to accomplish this is technetium 99m-labeled red cell scintigraphy, in which red blood cells are labeled with radioactivity, then 'tracked' by a scanning device. The value of technetium 99m-labeling was evaluated in 203 patients with gastrointestinal bleeding. The results showed that 26 percent (52 patients) of the scans positively identified a bleeding site. Evidence necessary to confirm the correctness of the scan was available in 22 of the 52 positive results. In 16 of these, the bleeding site was determined by other means, and in the other six, localization by the scan was probably incorrect, since bleeding began shortly after surgical treatment. Overall, the localization error rate was 25 percent. After 19 patients with positive scan results underwent surgery, the scan findings for eight of these patients proved to be incorrect. This implies that, if the technetium 99m scan were relied upon to direct surgery, an incorrect operation would be performed in at least 42 percent of the cases. The test does not localize the source of bleeding or direct surgery accurately enough to merit the use of this technique as a primary diagnostic tool, but may be helpful in providing supplemental information for other approaches to localizing gastrointestinal bleeding. (Consumer Summary produced by Reliance Medical Information, Inc.)

Diagnosis, Gastrointestinal bleeding, Gastrointestinal hemorrhage, PET imaging, Positron emission tomography

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