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Wed Sep 29 13:40:51 BST 2004

I have just done an after hours TOE (or TEE if you have an esophagus rather than an oesophagus) to prove that a CT appearance was artefact not an indication for surgery.

Middle aged, somewhat obese woman from a car crash, presents with sternal fracture. Because of mechanism of injury and difficulty interpreting CXR she has a chest CT. There is no need to post the images as they are identical to those posted by Andrew Bowman a few days ago. Radiologist is adamant there is a dissection flap in the ascending aorta. There is no mediastinal haematoma. Emergency physician points out that radiologist is talking about the wrong disease in the wrong location but the pressure is on to transfer to a cardac surgical centre. Radiologist made the statement that our new high speed 16 head helical CT does not cause artifacts (unlike the old CT scanner)!

Of course the TOE is totally normal and she is admitted to a ward with just a sternal fracture rather than a sternotomy!

The VOMIT disease is commoner than you think!!!

Cheers, Ian

Ian Seppelt FANZCA FJFICM
Staff Specialist in Anaesthesia and Intensive Care Medicine
The Nepean Hospital, 
PO Box 63, Penrith NSW 2751
Clinical Lecturer, University of Sydney

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VOMIT avoided