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Mon Sep 3 18:40:01 BST 2007

I think that the rigid esophagoscopy was a mistake, we stopped doing it and
always do a flexible esophagoscopy and bronchoscopy. The edema and "flap"
could be secondary to some damage form the rigid study and know there is a
real problem to rule out a real injury there.
I think the patient should be taken to the angio suite for an agiography at
once and the BARIUM study could be done there, immediately after the
angiography and if there is no vascular injury. 

Haim Paran

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of SJASMD at aol.com
Sent: Monday, September 03, 2007 5:49 AM
To: trauma-list at trauma.org
Subject: Re: GSW TO RIGHT CHEST. VICTIM OF MEDIOCRE IMAGING TECHNOLOGY

In a message dated 9/2/2007 5:57:01 P.M. W. Europe Daylight Time,  
KMATTOX at aol.com writes:

I will  repeat.   My last post stated, "Now, I want an   arteriogram."   I 
was 
more confused after reviewing the CT, so  Sal and  I are in agreement."

k

k
He continues to drain blood from his chest at about 100 cc per hour. Chest  
surgeon decides he needs no more imaging and takes the patient to the
operating 
 room. for scoping.
There bronchoscopy and rigid esophagography are performed. No injury is  
found.

Trauma surgeon still suspicious for aerodigestive injury gets ENT to do  
flexible esophagoscopy which reveals edema of the esophageal wall and a  
questionable "flap". So sounding like radiologists they equivocate. While
they  detect 
some injury, they can't really figure out at what level the injury  exists.

So they request the radiologist to do a swallow and take him out of the OR  
for another study. At this point all thoughts of vascular injury of the  
mediastinum or neck are forgotten

You and others have requested that BARIUM be used for the esophagogram Our  
surgeon desires gastrograffin. What to do and what is the evidence.

Sal

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GSW TO RIGHT CHEST. VICTIM OF MEDIOCRE IMAGING TECHNOLOGY