Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. *The views expressed in this manuscript are those of the author and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or United States Government. Reprint requests to: publications@acr.org Penetrating Neck Injury decrease in overall neck explorations and negative neck explorations as well as the use of catheter angiography and esophagography [17]. A recent retrospective study [18] reviewed the selective nonoperative management of patients with clinical hard signs. Of patients with hard signs who were hemodynamically stable and had a stable airway, 74% who received a CTA were able to avoid surgical neck exploration. In patients for whom the risk of allergic reaction to iodinated contrast is high or unknown, premedication may be appropriate per ACR recommendations [19]. If there is a high risk for contrast reaction or if iodinated contrast cannot be given, unenhanced computed tomography (CT) imaging of the neck may be performed, but with the understanding the vasculature may be underevaluated. Ultrasound (US) is limited in its use in patients with penetrating neck injury, given the effect of overlying or adjacent soft-tissue injury. It may be complicated by a cervical collar or overlying skin dressings, provides limited evaluation of surrounding structures, and is of limited use in zone I and III injuries [4,13,14,22,23]. Early studies comparing US and catheter-based angiography demonstrated a sensitivity of 91%, a specificity of 98% to 100%, a positive predictive value of 100%, and a negative predictive value of 99% for patients with clinical soft signs imaged by US [24,25]. Fluoroscopic upper gastrointestinal tract examination has its role in the evaluation of penetrating neck injuries but is typically used as a problem-solving modality [2,6,8].
Penetrating Neck Injury PCAs. Participation by representatives from collaborating societies on the expert panel does not necessarily imply individual or society endorsement of the final document. *The views expressed in this manuscript are those of the author and do not reflect the official policy of the Department of Army/Navy/Air Force, Department of Defense, or United States Government. Reprint requests to: publications@acr.org Penetrating Neck Injury decrease in overall neck explorations and negative neck explorations as well as the use of catheter angiography and esophagography [17]. A recent retrospective study [18] reviewed the selective nonoperative management of patients with clinical hard signs. Of patients with hard signs who were hemodynamically stable and had a stable airway, 74% who received a CTA were able to avoid surgical neck exploration. In patients for whom the risk of allergic reaction to iodinated contrast is high or unknown, premedication may be appropriate per ACR recommendations [19]. If there is a high risk for contrast reaction or if iodinated contrast cannot be given, unenhanced computed tomography (CT) imaging of the neck may be performed, but with the understanding the vasculature may be underevaluated. Ultrasound (US) is limited in its use in patients with penetrating neck injury, given the effect of overlying or adjacent soft-tissue injury. It may be complicated by a cervical collar or overlying skin dressings, provides limited evaluation of surrounding structures, and is of limited use in zone I and III injuries [4,13,14,22,23]. Early studies comparing US and catheter-based angiography demonstrated a sensitivity of 91%, a specificity of 98% to 100%, a positive predictive value of 100%, and a negative predictive value of 99% for patients with clinical soft signs imaged by US [24,25]. Fluoroscopic upper gastrointestinal tract examination has its role in the evaluation of penetrating neck injuries but is typically used as a problem-solving modality [2,6,8].