The mediastinum--Is it wide?

Gleeson, C E; Spedding, R L; Harding, Louise; Caplan, Michael J.

doi:10.1136/emj.18.3.183

Cited by 19 publications

(18 citation statements)

References 12 publications

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“…Mediastinal widening due to unusual amounts of fat accumulations is reported in the literature, which most often occurs with simple obesity, not associated with iatrogenic or primary steroid excess states [ 1 , 2 ]. Other causes of mediastinal widening include aortic dissection, lymphoma, thymoma, esophageal rupture, trauma or hemorrhage, and mediastinitis [ 3 , 4 ]. Increased amount of fat surrounding can also cause low voltages on electrocardiograms, but this has not been described in the literature.…”

Section: Discussionmentioning

confidence: 99%

Mediastinal lipomatosis as a cause of low voltage complexes on electrocardiogram and widened mediastinum: A case report

Puttarajappa

Dhoble

2008

Cases Journal

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Section: Discussionmentioning

confidence: 99%

Mediastinal lipomatosis as a cause of low voltage complexes on electrocardiogram and widened mediastinum: A case report

Puttarajappa

Dhoble

2008

Cases Journal

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“…Execution of CR in the supine (via portable CR) or upright position potentially affects the diagnostic accuracy of CR for AAS, as supine CR artificially increases mediastinum width . Many previous studies did not report the number of portable versus nonportable CR examinations.…”

Section: Discussionmentioning

confidence: 99%

Integrated Use of Conventional Chest Radiography Cannot Rule Out Acute Aortic Syndromes in Emergency Department Patients at Low Clinical Probability

Nazerian

Pivetta

Veglia

et al. 2019

Academic Emergency Medicine

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Objectives: Guidelines recommend chest radiography (CR) in the workup of suspected acute aortic syndromes (AASs) if the pretest clinical probability is low. However, the diagnostic impact of CR integration for the rule-in and rule-out of AASs is unknown. Methods:We performed a secondary analysis of the ADvISED multicenter study. Emergency department outpatients were eligible if an AAS was clinically suspected. Clinical probability was defined with the aortic dissection detection risk score (ADD-RS). CR was evaluated blindly by a radiologist, who judged on mediastinum enlargement (ME) and other signs.Results: In 2014 through 2016, a total of 1,129 patients were enrolled and 1,030 were analyzed, including 48 (4.7%) with AASs. ADD-RS/ME and ADD-RS/any CR sign (aCRs) integration were more accurate than ADD-RS alone (area under the curve = 0.8 and 0.78 vs. 0.66, p < 0.001). The sensitivity and specificity of the integrated strategies were 66.7% (95% confidence interval [CI] = 51.5% to 79.9%) and 82.5% (95% CI = 79.9% to 84.8%) for ADD-RS/ME and 68.8% (95% CI = 53.6% to 80.9%) and 76.5% (95% CI = 73.7% to 79.1%) for ADD-RS/ aCRs, respectively. The sensitivity and specificity of CR per se were 54.2% (95% CI = 39.2% to 68.6%) and 92.4% (95% CI = 90.5% to 93.9%) for ME and 60.4% (95% CI = 45.3% to 74.2%) and 85.2% (95% CI = 82.9% to 87.4%) for aCRs. The agreement (j) between attending physicians and radiologists for ME was 0.44 (95% CI = 0.35 to 0.54). ADD-RS/ME rule-in (ADD-RS ≤ 1 and ME-present, or ADD-RS > 1) applied to 204 versus 130 patients with ADD-RS > 1, including 14 with AAS and 60 false-positives (FP). ADD-RS/aCRs rule-in (ADD-RS ≤ 1 and aCRs-present, or ADD-RS > 1) applied to 264 patients, including 15 with AAS and 119 FP. ADD-RS/ME ruleout (ADD-RS ≤ 1 and ME-absent) applied to 826 (80.2%) patients, including 16 with AAS (33.3% of cases). ADD-

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“…Emergencies include aortic dissection, esophageal rupture, trauma, hemorrhage or mediastinitis. 12 Mediastinal widening on CXR can be followed up with immediate CT, MRI and Echocardiogram. Critical warning signs can be elicited on history and physical exam.…”

Section: Differentialmentioning

confidence: 99%

“…Notably, aortic dissection often manifests as sudden onset of sharp, tearing ripping pain in the chest or back with maximal intensity at onset leading to absent pulses, >20 BP mmHg difference in blood pressure between arms, and possible neurological abnormalities. 11,12 Other critical causes of mediastinal widening include anterior mediastinal masses such as lymphoma and thymoma, which can be distinguished from benign lipomatosis by imaging.…”

Section: Differentialmentioning

confidence: 99%