Asymptomatic penetrating neck injuries: Course and outcome following CT angiography and oesophagography.

BACKGROUND: Penetrating neck injuries (PNIs) are common, yet imaging protocols for asymptomatic patients remain debated in resource-limited settings. OBJECTIVES: Describe the clinical course, imaging findings and outcomes of asymptomatic PNI patients who underwent CT angiography and oesophagography (CTA&O) at a tertiary hospital in the Western Cape, South Africa. METHOD: A retrospective review of asymptomatic PNI patients who underwent CTA&O at Tygerberg Hospital between 01 January 2021 and 30 June 2022. Demographics, mechanism, imaging findings and outcomes were extracted from electronic hospital systems. RESULTS: Ninety-one patients were included (median age 30 years; 88 [97%] males; 84 [92%] stab wounds). Sixty (66%) had a normal CTA&O; 31 (34%) had 40 abnormalities (aerodigestive tract: n = 28 [70%]; vascular: n = 7 [17.5%]; orthopaedic n = 5 [12.5%]). Of these, 18/31 (58%) had no further investigation and 13/31 (42%) had 14 investigations. Most 17/18 (94%) suspected aerodigestive injury investigations were negative. One (3%) required facial artery embolization. There were no complications or deaths. CONCLUSION: CTA&O identified PNI-related radiological abnormalities in one-third of the asymptomatic PNI patients. Although most did not represent clinically important injuries requiring intervention, CTA&O is valuable for screening. These findings may improve CTA&O interpretation and reduce downstream investigations while ensuring safety. CONTRIBUTION: This study provides context-specific evidence on CTA&O findings in asymptomatic PNI patients. Distinguishing common PNI-related radiological abnormalities from clinically important findings may improve CTA&O interpretation and improve resource use.