MEDizzy - A 49-year-old man was the restrained driver in a motor

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Trauma II

A 49-year-old man was the restrained driver in a motor vehicle collision. He decelerated rapidly in order to avoid hitting another car and swerved into a ditch. He complains of chest pain. Which of the following findings on chest x-ray would be most suspicious for an aortic injury?

ExplanationD. There are multiple findings on chest x-ray that are suggestive of a thoracic aortic injury, such as widening of the mediastinum more than 8 cm (because of the presence of a mediastinal hematoma), loss of the aortic knob, deviation of the nasogastric tube in the esophagus, depression of the left mainstem bronchus, an apical cap (apical pleural hematoma), sternal or scapular fracture, multiple left-sided rib fractures, and massive left hemothorax. However, a normal chest x-ray does not rule out a diagnosis of a thoracic great vessel injury. If clinical suspicion is high, then further diagnostic workup should be pursued. Aortography, CT angiography, and transesophageal echocardiography may establish the diagnosis. Traumatic aortic injuries are deceleration injuries because of differential forces to the fixed and mobile parts of the thoracic aorta; most aortic injuries are located near the ligamentum arteriosus.