CT esophagography has been described for diagnosing suspected upper-digestive-tract injuries in the trauma setting. There are limited data on this imaging modality, which can be performed either in conjunction with the Penetrating Neck Injury Arteriography, MRI, MRA, US, and Esophagram Although catheter angiography, MRI, MRA, US, and fluoroscopic studies could be used in the initial evaluation of penetrating neck injury, these are typically relegated to problem solving for specific issues in contemporary trauma workups. Variant 2: Penetrating neck injury. Normal or equivocal CTA. Concern for vascular injury. Arteriography Catheter angiography was traditionally used in the evaluation of zones I and III but now is considered primarily in the evaluation of patients with a normal or equivocal CTA with a concerning penetrating foreign body trajectory [6,8] or when endovascular therapy is to be performed [1]. Catheter angiography may be performed in follow-up to equivocal CTA examinations, especially when a clinically significant vascular injury cannot be reliably excluded. A limitation of CTA is the potential for streak artifact from retained metallic foreign bodies; in this instance, digital subtraction catheter angiography may be more sensitive and appropriate for vascular evaluation [20,21]. US Studies in the 1990s demonstrated a high sensitivity and specificity, as well as positive and negative predictive values, of US in patients with penetrating injuries to the neck [24,25,31]. In considering the strengths of US evaluation versus the limitations as discussed, in only very specific circumstances may US provide additional diagnostic insight. For overall structural and functional assessment in the initial evaluation period, arteriography remains the preferred modality.
Penetrating Neck Injury PCAs. CT esophagography has been described for diagnosing suspected upper-digestive-tract injuries in the trauma setting. There are limited data on this imaging modality, which can be performed either in conjunction with the Penetrating Neck Injury Arteriography, MRI, MRA, US, and Esophagram Although catheter angiography, MRI, MRA, US, and fluoroscopic studies could be used in the initial evaluation of penetrating neck injury, these are typically relegated to problem solving for specific issues in contemporary trauma workups. Variant 2: Penetrating neck injury. Normal or equivocal CTA. Concern for vascular injury. Arteriography Catheter angiography was traditionally used in the evaluation of zones I and III but now is considered primarily in the evaluation of patients with a normal or equivocal CTA with a concerning penetrating foreign body trajectory [6,8] or when endovascular therapy is to be performed [1]. Catheter angiography may be performed in follow-up to equivocal CTA examinations, especially when a clinically significant vascular injury cannot be reliably excluded. A limitation of CTA is the potential for streak artifact from retained metallic foreign bodies; in this instance, digital subtraction catheter angiography may be more sensitive and appropriate for vascular evaluation [20,21]. US Studies in the 1990s demonstrated a high sensitivity and specificity, as well as positive and negative predictive values, of US in patients with penetrating injuries to the neck [24,25,31]. In considering the strengths of US evaluation versus the limitations as discussed, in only very specific circumstances may US provide additional diagnostic insight. For overall structural and functional assessment in the initial evaluation period, arteriography remains the preferred modality.