Transmediastinal gunshot injuries present the risk of immediately
life threatening injuries. Stable patients have been evaluated by a
combination of esophageal swallow and endoscopy, aortography and
bronchoscopy. There is an increasing trend favoring CT scan.
Unstable patients require immediate exploration, being prepared to
enter both hemi-thoraces. Selected References: * Bergsland J,
Karamanoukian HL, Soltoski PR, Salerno TA. Single suture
forcircumflex exposure in coronary artery bypass grafting. Ann
Thorac Surg.1999;68: 1428-1430. * Fedalen PA, Bard MR, Piacentino
V, et al. Intraluminal shunt placement and off- pump coronary
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1;50: 133-135 * Hanpeter DE, Demetriades D, Asensio JA, Berne TV,
Velmahos G, Murraygunshot wounds. J Trauma 2000;49(4):689-695. *
MacPherson D. Bullet Penetration: Modeling the dynamics and the
incapacitation resulting from wound trauma. Ballistics
Publications, EI Segundo, CA, 1994 * Wall MJ, Soltero E. Damage
control for thoracic injuries, Surg Clin North
AmI997;77(4):863-878. * Rozycki GS, Feliciano DV, Oschner MG,
Knudson MM, Hoyt DB, Davis F, Hammerman D, Figueredo V, Harviel JD,
Han DC, Schmidt JA. The role ofUltrasound in patients with possible
penetrating cardiac wounds: aProspective multicenter study. J
Trauma 1999; 46(4):543-552. * Roussseau H, Soula P, Bui B, D'Othee
BJ, Massabuau P, Meites G, Concina P,Mazzerolles M, Joffre F, Otal
P. Delayed treatment of traumatic ruptureof the thoracic aorta with
endoluminal covered stent. Circulation 1999 Feb2; 99(4): 498-504.
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