Monday, February 13, 2006

Tales from the Trauma Service XVI.....
20-ish youn man struck by a car. Diminished level of consciousness upon arrival and is intubated by the ED physician. His initial CXR:

Read as negative by the radiologist. The mediastinum is a little wide, but less than 8 cm. Off to CT he goes:

Looky here. The blue line indicates an intimal flap. Off to aortography:

A dissection distal to the left subclavian artery. The list of "classical" radiographic findings suggestive of aortic dissection are:

1) Widened mediastinum
2) Loss of aortic knob
3) Tracheal deviation to right
4) Loss of aortic-pulmonary window
5) Depression of left mainstem bronchus
6) Widened paratracheal stripe
7) Apical cap
8) Left hemothorax without rib fracture (also indicative of esophageal injury)
9) Deviation of NG tube
10) Fracture of scapula or first/second rib

Additionally anywhere from 3 to 20 percent of patients with normal CXR can have an aortic injury, depending on who you read. This young man was transferred to a referral center (my cardiothoracic coverage was unavailable) and underwent open repair of his injury without complication.
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