title: Is chest x-ray an adequate screening tool for the diagnosis of blunt thoracic aortic injury?
abstract: BACKGROUND
  Blunt thoracic aortic injuries (BTAI) have a high mortality rate. For survivors, chest X-ray (CXR) findings are used to determine the need for further diagnostic testing with chest computerized tomography with angiography (CTA) or conventional angiography. We set to determine the adequacy of utilizing CXR alone as a screening tool for BTAI.
  
  
  METHODS
  All patients diagnosed with BTAI at a level I trauma-center during a 7-year-period were identified. CXRs of these patients and those of a control group of blunt trauma patients with an injury severity score >15 were reviewed by four trauma surgeons blinded to the diagnosis. Based on each CXR viewed, the surgeons decided if they would have proceeded to chest CTA, angiography, or required no further studies to rule out BTAI.
  
  
  RESULTS
  In the 7-year-period, 83 patients had BTAI. CXRs were available in 45 patients. The four surgeons viewed 96 CXRs including those of 51 controls. Based on the CXR appearance in patients with BTAI, the surgeons chose to proceed to chest CTA in 38 patients (84.4%), conventional aortography in two patients (4.4%), and no further testing in five patients (11.2%). A widened mediastinum (75%) and loss of the aorto-pulmonary window (40%) were the most frequent CXR abnormalities. Patients with BTAI were more likely to have an abnormal CXR-40 of 45 (88.8%) patients when compared with the controls-25 of 51 (49%)patients-p < 0.001.
  
  
  CONCLUSIONS
  Although CXR is a sensitive screening modality, it failed to identify the possibility of BTAI in 11% of patients. The liberal use of chest CTA after high speed motor vehicle crashes is recommended to minimize the incidence of missed BTAI.
authors.affiliation: Department of Surgery, Wright State University, Dayton, Ohio, USA. peter.ekeh@wright.edu
authors.forename: Akpofure Peter
authors.initials: AP
authors.lastname: Ekeh
authors.forename: Wylan
authors.initials: W
authors.lastname: Peterson
authors.forename: Randy J
authors.initials: RJ
authors.lastname: Woods
authors.forename: Mbaga
authors.initials: M
authors.lastname: Walusimbi
authors.forename: Nancy
authors.initials: N
authors.lastname: Nwuneli
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Saxe
authors.forename: Mary C
authors.initials: MC
authors.lastname: McCarthy
mesh_terms: D000328:Adult; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging* / Q000293:injuries*; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D013902:Radiography, Thoracic; D013898:Thoracic Injuries / Q000000981:diagnostic imaging*; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging*