Assessment of Mediastinal Widening associated with Traumatic Rupture of the Aorta

Current Management of Traumatic Rupture of the Descending Thoracic Aorta

“…Plain chest radiograph (CXR) is the primary screening tool for patients who have sustained a severedeceleration injury, but it is generally accepted that between 2-7% of patients with a traumatic rupture have a normal CXR initially [19]. The incidence of the following plain radiographic findings among patients with diagnosed traumatic thoracic aortic rupture is: widened mediastinum, 89%; obscured aortic knob, 82%; loss of paraspinous stripe, 91%; loss of aortopulmonary window (25%) (all of these in conjunction with widened mediastinum) and bronchial depression, 25% [29, 30]. There is debate, however, on how accurately mediastinal widening can actually be determined [31, 32].…”

Determining Risk of Traumatic Aortic Injury

“…Accordingly, we did not consider the chest radiographic appearance of the mediastinum in our analysis. The effectiveness of screening with chest radiography has been vigorously debated elsewhere [3,6,7,9,10,13,17,19,20,30] and is beyond the scope of this analysis.…”

Analytic Review: Blunt Chest Trauma: The Intensivist's Perspective

“…The chest roentgenogram is very useful as a screening procedure, but definitive diagnosis requires arch aortography [33][34][35][36][37]. Widening or loss of the paravertebral stripe and displacement of the nasogastric tube to the right of midline also suggest mediastinal hemorrhage [40]. findings on a plain film suggestive of aortic injury indicate the presence of a mediastinal hematoma and include superior mediastinal widening equal to or greater than 8 cm on a standard 100-cm anteroposterior projection, shift of the trachea to the right of midline, loss of the sharp contour of the aortic knob, obliteration of the medial aspect of the left upper lobe, opacification of the clear space between the aorta and the pulmonary artery, and depression of the left mainstem bronchus [39].…”