CT vs Angio

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Ken,

I have too seen surgical disasters following misinterpretation of apparent
intimal flaps seen on CT and TOE. I recall one of my previous consultants in
London taking a female patient in her early 20s with Marfan's to theatre
because of a presumpative diagnosis of ascending aortic dissection based on
TOE imaging. Angiography was not performed..........

Her aortic root was known to be dilated and she had modest AR, but normal LV
function. At operation there was no evidence of aortic dissection - but he
elected to proceed to "elective" aortic root replacement using the Cabrol
technique - she died suddenly 6 weeks later following thrombosis of the
intercoronary dacron conduit.

John Black



-----Original Message-----
From: KMATTOX@aol.com [mailto:KMATTOX@aol.com]
Sent: 14 October 2002 23:30
To: trauma-list@trauma.org
Subject: Re: CT vs Angio


I looked closely at the submitted 2 CT scans of the ascending aorta.   As I 
stated earlier, we are in an evolutionary period where the newer technology 
shows us things that we cannot yet explain.    As a surgeon, a thoracic 
surgeon with considerable experience in vascular trauma, I would NEVER think

of operating solely on the basis of this CT of the ascending aorta and I 
could not defend in court anyone who did not get an aortogram in this
patient 
as described.  

I really really do not understand the fascination and support for CT in the 
acute evaluation of thoracic injury, and I surely do not understand why
there 
is so much reluctance to do the traditional and reliable aortography in such

cases.   We do arteriography at the drop of a hat for other injuries, such
as 
pelvic fractures and liver embolizations, but shy away from using it in
blunt 
injury to the thoracic aorta because of some articles written by some
general 
surgeons who never operate on the thoracic aorta.   Yes, I am aware of 
articles published by thoracic surgeons relating to descending thoracic 
aortic injury, but the latest article containing a very large series of
cases 
from a very large eastern hospital had NO injuries in any other location 
other than the proximal descending thoracic aorta and this paper EXCLUDED
and 
DID NOT REPORT a case reported in their last paper which reported a patient 
that died in the arteriogram suite after having a CT done for a suspicious 
mediastinum seen on regular chest X-ray.    Something is wrong with the 
arithmetic or many of the rest of us are seeing a totally different cohort
of 
patients than SOME of those who write about this injury.     

k  

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