European Radiology

, Volume 26, Issue 7, pp 2409–2417 | Cite as

Penetrating aerodigestive injuries in the neck: a proposed CT-aided modified selective management algorithm

  • Uttam K. BodanapallyEmail author
  • Kathirkamanathan Shanmuganathan
  • David Dreizin
  • Deborah Stein
  • Amit K. Reddy
  • Stuart E. Mirvis
  • Matthew Vasquez
  • Cassandra Cardarelli
  • Elizabeth Guardiani
Emergency Radiology



To determine the specific CT findings of penetrating neck wound profile predicting aerodigestive injuries, diagnostic performance of CTA and to propose a modified selective management algorithm to reduce nontherapeutic invasive procedures.


We retrospectively evaluated CTAs of 102 patients to determine the presence of various CT signs. “Trajectory”-based signs included trajectory of the wound extending into the aerodigestive tract and trajectory violating the deep neck spaces. “Conventional” signs included transcervical injury; wall defect; air or blood in the deep neck spaces; irregular or thickened aerodigestive tract; and active mucosal bleeding.


Trajectory of the wound extending into the aerodigestive tract (sensitivity 76 %, specificity 97 %) and trajectory of the wound violating the suprahyoid deep neck spaces or the infrahyoid visceral space (sensitivity 97 %, specificity 55 %) were the best predictors of injury on regression analysis. The most specific “conventional” CT signs were “wall defect” and “active mucosal bleed”, but had very low sensitivity. The sensitivity of CTA for detecting an injury ranged from 89.5 % to 92 %, specificity ranged from 62.5 % to 89 %.


CTA can be a useful technique in detecting aerodigestive injury. Our proposed management algorithm can exclude an injury with high degree of confidence (sensitivity 97 %).

Key Points

Trajectory-based CT signs predict aerodigestive injury after penetrating neck trauma.

Surgery should be considered when trajectory extends into the infra-arytenoid aerodigestive tract.

Endoscopy or exploration should be considered when trajectory violates deep neck spaces.

This modified approach can decrease negative explorations and invasive diagnostic procedures.


Neck injuries Wounds, penetrating Oesophageal perforation Multidetector-row computed tomography Imaging 



Presented at ARRS 2015. The scientific guarantor of this publication is Bodanapally, Uttam, K, MBBS. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. No complex statistical methods were necessary for this paper. Institutional review board approval was obtained. Written informed consent was waived by the institutional review board. Methodology: retrospective, diagnostic or prognostic study, performed at one institution.

Supplementary material

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Copyright information

© European Society of Radiology 2015

Authors and Affiliations

  • Uttam K. Bodanapally
    • 1
    • 2
    Email author
  • Kathirkamanathan Shanmuganathan
    • 1
    • 2
  • David Dreizin
    • 1
    • 2
  • Deborah Stein
    • 1
    • 3
  • Amit K. Reddy
    • 4
  • Stuart E. Mirvis
    • 1
    • 2
  • Matthew Vasquez
    • 1
    • 5
  • Cassandra Cardarelli
    • 1
    • 5
  • Elizabeth Guardiani
    • 1
    • 6
  1. 1.R Adams Cowley Shock Trauma CenterUniversity of Maryland Medical CenterBaltimoreUSA
  2. 2.Department of RadiologyUniversity of Maryland Medical CenterBaltimoreUSA
  3. 3.Department of SurgeryUniversity of Maryland Medical CenterBaltimoreUSA
  4. 4.University of Iowa Carver College of MedicineIowa CityUSA
  5. 5.Departement of SurgeryWalter Reed National Military Medical CenterBethesdaUSA
  6. 6.Department of Otorhinolaryngology-Head & Neck SurgeryUniversity of Maryland Medical CenterBaltimoreUSA

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