Blunt chest trauma and suspected aortic rupture: Reliability of chest radiograph findings

Marnocha, Kenneth E; Maglinte, D. T.; Woods, John R.; Peterson, Paul C; Dolan, Patrick A.; Nigh, Andrew; Goodman, Matthew

doi:10.1016/s0196-0644(85)80879-9

Cited by 20 publications

(5 citation statements)

References 20 publications

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“…Much had been mentioned regarding the diagnostic accuracy of various findings on chest radiograph as indicator of thoracic aortic rupture in blunt chest trauma. These included widening of the mediastinum, blurring of the aortic knob or aortic knob width, tracheal shifting to the right, left apical cap, depression of the left mainstem bronchus below 40°, widened left paraspinal line, abnormal MW–chest width ratio, hemothorax, pneumothorax, and rib fractures [14–18]. MW >8 cm had been a widely used screening tool for aortic rupture [19–21].…”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of mediastinal width measurement on posteroanterior and anteroposterior chest radiographs in the depiction of acute nontraumatic thoracic aortic dissection

et al. 2012

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We aimed to explore the diagnostic accuracy of various mediastinal measurements in determining acute nontraumatic thoracic aortic dissection with respect to posteroanterior (PA) and anteroposterior (AP) chest radiographs, which had received little attention so far. We retrospectively reviewed 100 patients (50 PA and 50 AP chest radiographs) with confirmed acute thoracic aortic dissection and 120 patients (60 PA and 60 AP chest radiographs) with confirmed normal aorta. Those who had prior history of trauma or aortic disease were excluded. The maximal mediastinal width (MW) and maximal left mediastinal width (LMW) were measured by two independent radiologists and the mediastinal width ratio (MWR) was calculated. Statistical analysis was then performed with independent sample t test. PA projection was significantly more accurate than AP projection, achieving higher sensitivity and specificity. LMW and MW were the most powerful parameters on PA and AP chest radiographs, respectively. The optimal cutoff levels were LMW = 4.95 cm (sensitivity, 90 %; specificity, 90 %) and MW = 7.45 cm (sensitivity, 90 %; specificity, 88.3 %) for PA projection and LMW = 5.45 cm (sensitivity, 76 %; specificity, 65 %) and MW = 8.65 cm (sensitivity, 72 %; specificity, 80 %) for AP projection. MWR was found less useful and less reliable. The use of LMW alone in PA film would allow more accurate prediction of aortic dissection. PA chest radiograph has a higher diagnostic accuracy when compared with AP chest radiograph, with negative PA chest radiograph showing less probability for aortic dissection. Lower threshold for proceeding to computed tomography aortogram is recommended however, especially in the elderly and patients with widened mediastinum on AP chest radiograph.

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Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of mediastinal width measurement on posteroanterior and anteroposterior chest radiographs in the depiction of acute nontraumatic thoracic aortic dissection

et al. 2012

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“…6,7 It is currently a widespread policy to perform aortography only in the presence of an abnormal mediastinum. 8,9 However, with such a policy there is a significant risk of missing many aortic injuries.…”

Section: Methodsmentioning

confidence: 99%

Routine Helical Computed Tomographic Evaluation of the Mediastinum in High-Risk Blunt Trauma Patients

Δημητριάδης¹

1998

Arch Surg

136

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“…Finally, we have several findings regarding screening markers that may inform decisions for the ordering of chest CT to detect aortic injury. Counter to classic teachings, widened mediastinum and abnormal CXR had low sensitivity for aortic injury. The sensitivities of high‐energy mechanism and distracting injury are higher, but still insufficient for use as rule‐out criteria.…”

Section: Discussionmentioning

confidence: 99%

Blunt Traumatic Aortic Injury in the Pan‐scan Era

Baumann

Raja

et al. 2019

Academic Emergency Medicine

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Background: In the era of frequent head-to-pelvis computed tomography (CT) for adult blunt trauma evaluation, we sought to update teachings regarding aortic injury by determining 1) the incidence of aortic injury; 2) the proportion of patients with isolated aortic injury (without other concomitant thoracic injury); 3) the clinical implications of aortic injury (hospital mortality, length of stay [LOS], and rate of surgical interventions); and 4) the screening value of traditional risk factors/markers (such as high-energy mechanism and widened mediastinum on chest x-ray [CXR]) for aortic injury, compared to newer criteria from the recently developed NEXUS Chest CT decision instrument (DI). Methods:We conducted a preplanned analysis of patients prospectively enrolled in the NEXUS Chest studies at 10 Level I trauma centers with the following inclusion criteria: age > 14 years, blunt trauma within 6 hours of ED presentation, and receiving chest imaging during ED trauma evaluation.Results: Of 24,010 enrolled subjects, 42 (0.17%, 95% confidence interval [CI] = 0.13% to 0.24%) had aortic injury. Most patients (79%, 95% CI = 64% to 88%) had an associated thoracic injury, with rib fractures, pneumothorax/hemothorax, and pulmonary contusion occurring most frequently. Compared to patients without aortic injury this cohort had similar mortality (9.5%, 95% CI = 3.8% to 22.1% vs. 5.8%, 95% CI = 5.4% to 6.3%), longer median hospital LOS (11 days vs. 3 days, p < 0.01), and higher median Injury Severity Score (29 vs. 5, p < 0.001). High-energy mechanism and widened mediastinum on CXR had low sensitivity for aortic injury (76% [95% CI = 62% to 87%] and 33% [95% CI = 21% to 49%], respectively), compared to the NEXUS Chest CT DI (sensitivity 100% [95% CI = 92% to 100%]).Conclusions: Aortic injury is rare in adult ED blunt trauma patients who survive to receive imaging. Most ED aortic injury patients have associated thoracic injuries and survive to hospital discharge. Widened mediastinum on CXR and high-energy mechanism have relatively low screening sensitivity for aortic injury, but the NEXUS Chest DI detected all cases.From the

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Blunt chest trauma and suspected aortic rupture: Reliability of chest radiograph findings

Cited by 20 publications

References 20 publications

Diagnostic accuracy of mediastinal width measurement on posteroanterior and anteroposterior chest radiographs in the depiction of acute nontraumatic thoracic aortic dissection

Diagnostic accuracy of mediastinal width measurement on posteroanterior and anteroposterior chest radiographs in the depiction of acute nontraumatic thoracic aortic dissection

Routine Helical Computed Tomographic Evaluation of the Mediastinum in High-Risk Blunt Trauma Patients

Blunt Traumatic Aortic Injury in the Pan‐scan Era

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