MRA MRA may be feasible in the clinically stable patient for the evaluation of vascular injuries, although limitations such as potential retained foreign bodies and length of the examination may preclude its use [4,13,15,23]. In select and appropriate patients, MRI techniques, including 2-D and 3-D time-of-flight, contrast-enhanced time-resolved, and phase-contrast techniques, are available to evaluate the neck vasculature [32]. The 2-D and 3-D time-of-flight techniques do not require contrast for their technique. Variant 3: Penetrating neck injury. Normal or equivocal CTA. Concern for aerodigestive injury. Barium Swallow Various algorithms are present in practice for the use of esophagrams in the evaluation of aerodigestive injury in the patient with penetrating neck injury. These algorithms vary depending on factors such as whether or not the patient is symptomatic, the degree of clinical concern, the outcome of the initial CT or CTA, and the mechanism of injury [2,6,8,11]. Ahmed et al [27] argue that contrast fluoroscopic studies should not be used in the evaluation of oropharyngeal and hypopharyngeal injuries given that water-soluble and thin barium examinations missed 13 of 13 injuries in this area, compared with video endoscopy performed at the bedside. Water-soluble contrast is preferred, because there is the risk of extraluminal contrast extravasation. Panendoscopy with laryngoscopy, bronchoscopy, and esophagoscopy (flexible and rigid) is the gold standard to rule out oropharyngeal, hypopharyngeal, laryngotracheal, and esophageal injuries. MRI Overall, CT or CTA is preferred when evaluating for acute osseous and soft-tissue cervical injuries. MRI, in particular fat-suppressed T2-weighted imaging, is more sensitive for assessing potential cartilaginous and fibrous injuries but is relegated to specific problem-solving cases and is not routinely performed [26].
Penetrating Neck Injury PCAs. MRA MRA may be feasible in the clinically stable patient for the evaluation of vascular injuries, although limitations such as potential retained foreign bodies and length of the examination may preclude its use [4,13,15,23]. In select and appropriate patients, MRI techniques, including 2-D and 3-D time-of-flight, contrast-enhanced time-resolved, and phase-contrast techniques, are available to evaluate the neck vasculature [32]. The 2-D and 3-D time-of-flight techniques do not require contrast for their technique. Variant 3: Penetrating neck injury. Normal or equivocal CTA. Concern for aerodigestive injury. Barium Swallow Various algorithms are present in practice for the use of esophagrams in the evaluation of aerodigestive injury in the patient with penetrating neck injury. These algorithms vary depending on factors such as whether or not the patient is symptomatic, the degree of clinical concern, the outcome of the initial CT or CTA, and the mechanism of injury [2,6,8,11]. Ahmed et al [27] argue that contrast fluoroscopic studies should not be used in the evaluation of oropharyngeal and hypopharyngeal injuries given that water-soluble and thin barium examinations missed 13 of 13 injuries in this area, compared with video endoscopy performed at the bedside. Water-soluble contrast is preferred, because there is the risk of extraluminal contrast extravasation. Panendoscopy with laryngoscopy, bronchoscopy, and esophagoscopy (flexible and rigid) is the gold standard to rule out oropharyngeal, hypopharyngeal, laryngotracheal, and esophageal injuries. MRI Overall, CT or CTA is preferred when evaluating for acute osseous and soft-tissue cervical injuries. MRI, in particular fat-suppressed T2-weighted imaging, is more sensitive for assessing potential cartilaginous and fibrous injuries but is relegated to specific problem-solving cases and is not routinely performed [26].