Indications for aortography. Radiography after blunt chest trauma: a reassessment of the radiographic findings associated with traumatic rupture of the aorta.
Indications for aortography in truncal trauma patients have expanded as reports of radiographic findings associated with traumatic rupture of the aorta (TRA) have proliferated. By studying to what extent these findings also occurred in trauma patients without TRA, we determined the utility of these findings in selecting patients for aortography. The detection of nine radiographic findings associated with TRA was tabulated in 173 patients undergoing arch aortography to rule out TRA from 1975 to 1980. Twenty-five of these had TRA. All patients with TRA under age 65 had a widened mediastinum (WM); this was the only finding that taken alone correlated significantly with TRA (P = 0.001). Only two of six patients with TRA over 65 had a WM. Other findings such as hemothorax, fracture of ribs 1 or 2, pulmonary contusion, or multiple rib fracture were more likely to be found in patients without TRA. Formal radiographic interpretation by staff radiologists detected more radiographic abnormalities than physicians caring for the patient emergencly, who had access to a junior radiology resident. However, these physicians were as successful as staff radiologists in detecting WM when it was associated with TRA. A widened mediastinum is the best single criterion for aortography in young trauma patients; all elderly persons with severe truncal trauma should probably have aortography even in the absence of mediastinal widening. Radiologic consultation is important for complete detection of thoracic pathology in trauma patients, but in this study late interpretation of more subtle findings did not detect additional patients with TRA.
D000293:Adolescent; D000328:Adult; D000368:Aged; D001019:Aortic Rupture / Q000000981:diagnostic imaging*; D001027:Aortography; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013898:Thoracic Injuries / Q000000981:diagnostic imaging; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*