Skip to main content

Advertisement

SpringerLink
Log in

Penetrating neck trauma: radiological predictors of vascular injury

  • Head and Neck
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

Vascular injury in penetrating neck trauma predicts a poorer outcome and usually requires surgical neck exploration. Multi-detector computed tomography (MDCT) angiography is a readily available non-invasive diagnostic tool that can identify direct and indirect signs of vascular injury in stable patients. This study aims to investigate the diagnostic accuracy of radiological signs of vascular injury on MDCT, and their implications on patient management in the setting of penetrating neck trauma.

Methods

A retrospective cohort study of penetrating neck injuries (PNI) between 2012 and 2018 in a UK major trauma centre was performed. Clinical data and operative findings were compared with radiological findings on MDCT performed at the time of admission.

Results

157 patients were identified with PNI in the study period, with 67 meeting inclusion criteria. The predictive value of indirect radiological signs of vascular injury alone was low, with only 12.1% of these patients having significant vascular injury found at neck exploration. However, the combined use of direct radiological signs with clinical signs resulted in a specificity of 97.7% for vascular injury.

Conclusions

The use of direct and indirect radiological signs of vascular injury can increase the accuracy of diagnosis when used in conjunction with clinical signs. Combining clinical assessment and radiological investigation, specifically contrast-enhanced MDCT, improves the specificity in pre-operative assessment of potential vascular injury in PNI. MDCT is recommended in stable patients with clinical signs of vascular injury to reduce the rate of negative neck exploration.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Sperry JL, Moore EE, Coimbra R, Croce M, Davis JW, Karmy-Jones R, McIntyre RC Jr, Moore FA, Malhotra A, Shatz DV, Biffl WL (2013) Western trauma association critical decisions in trauma: penetrating neck trauma. J Trauma Acute Care Surg 75:936–940

    Article  PubMed  Google Scholar 

  2. Nason RW, Assuras GN, Gray PR, Lipschitz J (2001) Penetrating neck injuries: analysis of experience from a Canadian trauma centre Canadian Journal of Surgery. Journal Canadien de Chirurgie 44:122–126

    CAS  PubMed  Google Scholar 

  3. Steenburg SD, Sliker CW, Shanmuganathan K, Siegel EL (2010) Imaging evaluation of penetrating neck injuries. RadioGraphics 30:869–886

    Article  PubMed  Google Scholar 

  4. Monson DO, Saletta JD, Freeark RJ (1969) Carotid vertebral trauma. J Trauma 9:987–999

    Article  CAS  PubMed  Google Scholar 

  5. Roon AJ, Christensen N (1979) Evaluation and treatment of penetrating cervical injuries. J Trauma 19:391–397

    Article  CAS  PubMed  Google Scholar 

  6. Prichayudh S, Choadrachata-anun J, Sriussadaporn S, Pak-art R, Sriussadaporn S, Kritayakirana K, Samorn P (2015) Selective management of penetrating neck injuries using “no zone” approach. Injury 46(9):1720–1725

    Article  PubMed  Google Scholar 

  7. Ibraheem K, Khan M, Rhee P, Azim A, O'Keeffe T, Tang A, Kulvatunyou N, Joseph B (2018) “No zone” approach in penetrating neck trauma reduces unnecessary computed tomography angiography and negative explorations. J Surg Res 221:113–120

    Article  PubMed  Google Scholar 

  8. Woo K, Magner DP, Wilson MT, Margulies DR (2005) CT angiography in penetrating neck trauma reduces the need for operative neck exploration. Am Surg 71:754–758

    PubMed  Google Scholar 

  9. Kendall JL, Anglin D, Demetriades D (1998) Penetrating neck trauma. Emerg Med Clin North Am 16:85–105

    Article  CAS  PubMed  Google Scholar 

  10. Múnera F, Soto JA, Palacio DM, Castaneda J, Morales C, Sanabria A, Gutierrez JE, Garcia G (2002) Penetrating neck injuries: helical CT angiography for initial evaluation. Radiology 224:366–372

    Article  PubMed  Google Scholar 

  11. Núñez DB, Torres-León M, Múnera F (2004) Vascular injuries of the neck and thoracic inlet: helical CT–angiographic correlation. RadioGraphics 24:1087–1098

    Article  PubMed  Google Scholar 

  12. Demetriades D, Velmahos GG, Asensio JA (2001) Cervical pharyngoesophageal and laryngotracheal injuries. World J Surg 25:1044–1048

    Article  CAS  PubMed  Google Scholar 

  13. Mahmoodie M, Sanei B, Moazeni-Bistgani M, Namgar M (2012) Penetrating neck trauma: review of 192 cases. Arch Trauma Res 1:14–18

    Article  PubMed  PubMed Central  Google Scholar 

  14. Bodanapally UK, Shanmuganathan K, Dreizin D, Stein D, Reddy AK, Mirvis SE, Vasquez M, Cardarelli C, Guardiani E (2016) Penetrating aerodigestive injuries in the neck: a proposed CT-aided modified selective management algorithm. Eur Radiol 26:2409–2417

    Article  PubMed  Google Scholar 

  15. Olding J, Olding C, Fan K, Bew D (2019) Penetrating head & neck trauma–Epidemiology and injury characteristics in terror-related violence, interpersonal violence and deliberate self-harm at a level 1 trauma centre. The Surgeon Feb 23

  16. Siau RT, Moore A, Ahmed T, Lee MS, Tostevin P (2013) Management of penetrating neck injuries at a London trauma centre. Eur Arch Otorhinolaryngol 270:2123–2128

    Article  PubMed  Google Scholar 

  17. Inaba K, Munera F, McKenney M, Rivas L, de Moya M, Bahouth H, Cohn S (2006) Prospective evaluation of screening multislice helical CTA in the initial evaluation of penetrating neck injuries. J Trauma Injury Infection Crit Care 61:144–156

    Article  Google Scholar 

  18. Schroll R, Fontenot T, Lipcsey M, Heaney JB, Marr A, Meade P, McSwain N, Duchesne J (2015) Role of computed tomography angiography in the management of Zone II penetrating neck trauma in patients with clinical hard signs. J Trauma Acute Care Surg 79:943–950

    Article  PubMed  Google Scholar 

  19. Bell RB, Osborn T, Dierks EJ, Potter BE, Long WB (2007) Management of penetrating neck injuries: a new paradigm for civilian trauma. J Oral Maxillofac Surg 65:691–705

    Article  PubMed  Google Scholar 

  20. Múnera F, Soto JA, Palacio D, Velez SM, Medina E (2000) Diagnosis of arterial injuries caused by penetrating trauma to the neck: comparison of helical CT angiography and conventional angiography. Radiology 216:356–362

    Article  PubMed  Google Scholar 

  21. Osborn TM, Bell RB, Qaisi W, Long WB (2008) Computed tomographic angiography as an aid to clinical decision making in the selective management of penetrating injuries to the neck: a reduction in the need for operative exploration. J Trauma 64:1466–1471

    Article  PubMed  Google Scholar 

  22. Nasr A, Oliviera JT, Mazepa MM, Albuquerque CL, Martini GS, Nazario M, Carvalho FH (2015) Evaluation of the use of tomography in penetrating neck trauma. Revista do Colégio Brasileiro de CirurgiõesAug 42:215–219

    Article  Google Scholar 

Download references

Funding

The authors declare that they have no sources of funding.

Author information

Author notes

  1. Daniele Borsetto and Jonathan Fussey contributed equally to this work.

  2. Steve Colley and Paul Pracy equal senior contributors.

Authors and Affiliations

  1. Department of ENT Head and Neck Surgery, Queen Elizabeth University Hospital, Mindelsohn Way, BirminghamBirmingham, B15 2TH, UK

    Daniele Borsetto, Jonathan Fussey & Paul Pracy

  2. Department of Radiology, Queen Elizabeth Hospital, Birmingham, UK

    Jacqueline Mavuti & Steve Colley

Authors
  1. Daniele Borsetto
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jonathan Fussey
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jacqueline Mavuti
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Steve Colley
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Paul Pracy
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniele Borsetto.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Borsetto, D., Fussey, J., Mavuti, J. et al. Penetrating neck trauma: radiological predictors of vascular injury. Eur Arch Otorhinolaryngol 276, 2541–2547 (2019). https://doi.org/10.1007/s00405-019-05517-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-019-05517-2

Keywords

Search

Navigation