Transesophageal echocardiography (TEE) provides an intimate glimpse of the heart and mediastinum not always afforded by traditional transthoracic echo. It allows evaluation of the aorta and even the pulmonary arteries in addition to striking detail of cardiac valves and wall motion.

While TEE has been used to diagnose suspected pulmonary embolism and myocardial infarction, some of the best data comes from the trauma literature. In several studies, TEE was very quick and accurate in the diagnosis of traumatic aortic disruption.^140-142 However, a few early studies yielded a large number of false positive and falsenegative studies.¹⁴³ At this time, TEE is used primarily in the unstable patient with a wide mediastinum and multiple injuries (who is not a candidate for CT scanning). Significantly, in none of these studies was the emergency physician the primary individual performing the TEE.

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