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

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Abstract

Objectives

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.

Methods

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.

Results

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 %.

Conclusion

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.

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Acknowledgments

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.

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Authors and Affiliations

  1. R Adams Cowley Shock Trauma Center, University of Maryland Medical Center, 22S Greene Street, Baltimore, MD, USA

    Uttam K. Bodanapally, Kathirkamanathan Shanmuganathan, David Dreizin, Deborah Stein, Stuart E. Mirvis, Matthew Vasquez, Cassandra Cardarelli & Elizabeth Guardiani

  2. Department of Radiology, University of Maryland Medical Center, 22S Greene Street, Baltimore, MD, USA

    Uttam K. Bodanapally, Kathirkamanathan Shanmuganathan, David Dreizin & Stuart E. Mirvis

  3. Department of Surgery, University of Maryland Medical Center, 22S Greene Street, Baltimore, MD, USA

    Deborah Stein

  4. University of Iowa Carver College of Medicine, Iowa City, IA, USA

    Amit K. Reddy

  5. Departement of Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA

    Matthew Vasquez & Cassandra Cardarelli

  6. Department of Otorhinolaryngology-Head & Neck Surgery, University of Maryland Medical Center, 22S Greene Street, Baltimore, MD, USA

    Elizabeth Guardiani

Authors
  1. Uttam K. Bodanapally
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  2. Kathirkamanathan Shanmuganathan
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  3. David Dreizin
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  4. Deborah Stein
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Corresponding author

Correspondence to Uttam K. Bodanapally.

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Bodanapally, U.K., Shanmuganathan, K., Dreizin, D. et al. Penetrating aerodigestive injuries in the neck: a proposed CT-aided modified selective management algorithm. Eur Radiol 26, 2409–2417 (2016). https://doi.org/10.1007/s00330-015-4050-3

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  • DOI: https://doi.org/10.1007/s00330-015-4050-3

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