Barium swallow, preferably with water-soluble contrast, may miss significant oropharyngeal and hypopharyngeal injuries, although this imaging examination will typically detect esophageal injuries [27]. As arterial injury occurs in a proportion of patients with penetrating neck injury, one must be cognizant of the possibility of end-organ injury, particularly to the brain. Although not directly related to imaging of the neck in penetrating injuries, imaging of the brain and cerebral vasculature may be considered where cervical vascular injury is determined either by clinical examination, imaging, or surgery. Discussion of Procedures by Variant Variant 1: Penetrating neck injury. Clinical soft injury signs. Radiography Radiographs are ubiquitous in radiology and in some practices may be employed in the initial evaluation of acute trauma patients [28]. In the initial evaluation in the trauma bay, radiographs of the neck may demonstrate radio- opaque foreign bodies, soft-tissue swelling, airway competency, fractures, and subcutaneous emphysema. With the exception of patients exhibiting clear hard signs necessitating immediate surgical intervention, the initial radiographs are generally followed by a more detailed CT or CTA evaluation. CTA After the clinical determination is made regarding the need for immediate surgical exploration (eg, presence of hard versus soft signs), CTA is considered the first-line imaging evaluation, replacing catheter angiography as the preferred modality. Multiple studies have shown CTA to have high sensitivity, in the range of 90% to 100%; specificity ranging from 98.6% to 100%; a positive predictive value of 92.8% to 100%; and a negative predictive value of 98% to 100% [5,12,14] for evaluating vascular injury. In addition to identifying vascular injury, CTA simultaneously identifies extravascular soft-tissue and aerodigestive injuries with a sensitivity of 100% and a specificity ranging from 93.5% to 97.5% [2,5,6,8,12-14,17,29].
Penetrating Neck Injury PCAs. Barium swallow, preferably with water-soluble contrast, may miss significant oropharyngeal and hypopharyngeal injuries, although this imaging examination will typically detect esophageal injuries [27]. As arterial injury occurs in a proportion of patients with penetrating neck injury, one must be cognizant of the possibility of end-organ injury, particularly to the brain. Although not directly related to imaging of the neck in penetrating injuries, imaging of the brain and cerebral vasculature may be considered where cervical vascular injury is determined either by clinical examination, imaging, or surgery. Discussion of Procedures by Variant Variant 1: Penetrating neck injury. Clinical soft injury signs. Radiography Radiographs are ubiquitous in radiology and in some practices may be employed in the initial evaluation of acute trauma patients [28]. In the initial evaluation in the trauma bay, radiographs of the neck may demonstrate radio- opaque foreign bodies, soft-tissue swelling, airway competency, fractures, and subcutaneous emphysema. With the exception of patients exhibiting clear hard signs necessitating immediate surgical intervention, the initial radiographs are generally followed by a more detailed CT or CTA evaluation. CTA After the clinical determination is made regarding the need for immediate surgical exploration (eg, presence of hard versus soft signs), CTA is considered the first-line imaging evaluation, replacing catheter angiography as the preferred modality. Multiple studies have shown CTA to have high sensitivity, in the range of 90% to 100%; specificity ranging from 98.6% to 100%; a positive predictive value of 92.8% to 100%; and a negative predictive value of 98% to 100% [5,12,14] for evaluating vascular injury. In addition to identifying vascular injury, CTA simultaneously identifies extravascular soft-tissue and aerodigestive injuries with a sensitivity of 100% and a specificity ranging from 93.5% to 97.5% [2,5,6,8,12-14,17,29].