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Ann Thorac Surg 1984;37:171-178
© 1984 The Society of Thoracic Surgeons

Articles

Radiographic Manifestations of Mediastinal Hemorrhage from Blunt Chest Trauma

John H. Woodring, M.D.*, Marcus L. Dillon, M.D.

From the Departments of Diagnostic Radiology and Cardiovascular and Thoracic Surgery, University of Kentucky Medical Center, Lexington, KY

* Address reprint requests to Dr. Woodring, Department of Diagnostic Radiology, University of Kentucky, Lexington, KY 40536


   Abstract
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 Abstract
References
 
The diagnosis of rupture of the thoracic aorta or its major branches depends largely on the recognition of mediastinal hemorrhage from the initial chest radiograph and subsequent thoracic aortography. This review discusses the radiographic manifestations of mediastinal hemorrhage, including widening of the mediastinum; a ratio of mediastinal width to chest width greater than 0.25; abnormalities of aortic contour; opacification of the aortopulmonary window; depression of the left main bronchus; deviation of the trachea to the right; deviation of the nasogastric tube to the right; the apical cap sign; widening of the paraspinal lines; widening of the right paratracheal stripe; and left hemothorax. The relationship of these manifestations to major thoracic arterial injury is examined. Pitfalls in the radiographic evaluation of mediastinal abnormalities are considered, and indications for computed tomography of the thorax and thoracic aortography in the severely injured patient are reviewed.


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 Abstract
 References
 

  1. Greendyke RM. Traumatic rupture of aorta: special reference to automobile accidents JAMA 1966;195:119.[Medline]
  2. Griffith GL, Mattingly Jr WT, Todd EP. Current diagnosis and management of blunt thoracic aortic trauma J Ky Med Assoc 1981;79:588.[Medline]
  3. O'Sullivan Jr MJ, Folkerth TL, Morgan JR, Fosburg RG. Post-traumatic thoracic aortic aneurysm: recognition and treatment Arch Surg 1972;105:14.[Medline]
  4. Parmley LF, Mattingly TW, Manion WC, Jahnke Jr EJ. Nonpenetrating traumatic injury of the aorta Circulation 1953;17:1086.
  5. Kirsh MM, Crane JD, Kahn DR, et al. Roentgenographic evaluation of traumatic rupture of the aorta Surg Gynecol Obstet 1970;131:900.[Medline]
  6. Corso PJ. Chest trauma Primary Care 1978;5:543.[Medline]
  7. McClenathan JE, Brettschneider L. Traumatic thoracic aortic aneurysms J Thorac Cardiovasc Surg 1965;50:74.[Medline]
  8. DeBoer HHM, Kwan TS. Traumatic aneurysm of the thoracic aorta Arch Chir Neerl 1971;23:117.[Medline]
  9. Rich NM, Spencer FC. Vascular Trauma. Philadelphia: Saunders; 1978. pp. 425-440.
  10. Bennett DE, Cherry JK. The natural history of traumatic aneurysm of the aorta Surgery 1967;61:516.[Medline]
  11. Pickard LR, Mattox KL, Espada R, et al. Transection of the descending thoracic aorta secondary to blunt trauma J Trauma 1977;17:749.[Medline]
  12. Katz S. Traumatic rupture of the thoracic aorta J Maine Med Assoc 1977;68:304.[Medline]
  13. Kirsh MM, Behrendt DM, Orringer MB, et al. The treatment of acute traumatic rupture of the aorta: a 10-year experience Ann Surg 1976;184:308.[Medline]
  14. Turney SZ, Attar S, Ayella R, et al. Traumatic rupture of the aorta: a five-year experience J Thorac Cardiovasc Surg 1976;72:727.[Abstract]
  15. Klatz O, Simpson W. Spontaneous rupture of the aorta Am J Med Sci 1932;184:455.
  16. Zehnder MA. Delayed post-traumatic rupture of the aorta in a young healthy individual after closed injury: mechanical-etiological considerations Angiology 1956;7:252.[Medline]
  17. Castagna J, Nelson RJ. Blunt injuries to branches of the aortic arch J Thorac Cardiovasc Surg 1975;69:521.[Abstract]
  18. Clarke CP, Brandt PWT, Cole DS, Barratt-Boyes BG. Traumatic rupture of the thoracic aorta: diagnosis and treatment Br J Surg 1967;54:353.[Medline]
  19. Sanborn JC, Heitzman ER, Markarian B. Traumatic rupture of the thoracic aorta: roentgen-pathological correlations Radiology 1970;95:293.[Abstract/Free Full Text]
  20. Fisher RG, Hadlock F, Ben-Menachem Y. Laceration of the thoracic aorta and brachiocephalic arteries by blunt trauma: report of 54 cases and review of the literature Radiol Clin North Am 1981;19:91.[Medline]
  21. Hirsch JH, Carter SJ, Chikos PM. Traumatic pseudoaneurysms of the thoracic aorta: two unusual cases AJR 1978;130:157.[Medline]
  22. Eller JL, Ziter Jr FMH. Avulsion of the innominate artery from the aortic arch: an evaluation of roentgenographic findings Radiology 1970;94:75.[Abstract/Free Full Text]
  23. Sturm JT, Strate RG, Mowlem A, et al. Blunt trauma to the subclavian artery Surg Gynecol Obstet 1974;138:915.[Medline]
  24. Freed TA, Bosher Jr LH. Arteriographic demonstration of laceration of great vessels secondary to blunt chest trauma Radiology 1968;90:88.[Abstract/Free Full Text]
  25. Fishbone G, Robbins DI, Osborn DJ, Grnja V. Trauma to the thoracic aorta and great vessels Radiol Clin North Am 1973;11:543.[Medline]
  26. Galbraith NF, Urschel Jr HC, Wood RE, et al. Fracture of first rib associated with laceration of subclavian artery: report of a case and review of the literature J Thorac Cardiovasc Surg 1973;65:649.[Medline]
  27. Fisher RD, Rienhoff III WF. Subclavian artery laceration resulting from fractured first rib J Trauma 1966;6:579.[Medline]
  28. Marsh DG, Sturm JT. Traumatic aortic rupture: roentgenographic indications for angiography Ann Thorac Surg 1976;21:337.[Abstract/Free Full Text]
  29. Seltzer SE, D'Orsi C, Kirshner R, DeWeese JA. Traumatic aortic rupture: plain radiographic findings AJR 1981;137:1011.[Abstract/Free Full Text]
  30. Cooley RN, Schreiber MH. Radiology of the Heart and Great Vessels. Third edition. Baltimore: Williams & Wilkins; 1978. pp. 565-569.
  31. Koroxenidis GR, Moschos CB, Landy ED, et al. Traumatic rupture of the thoracic aorta simulating coarctation Am J Cardiol 1965;16:605.[Medline]
  32. Sandor F. Incidence and significance of traumatic mediastinal haematoma Thorax 1967;22:43.[Free Full Text]
  33. Fraser RG, Pare JAP. Second edition. Diagnosis of Diseases of the Chest. vol 3. Philadelphia: Saunders; 1979. pp. 1594-1597.
  34. Mulder DS. Chest trauma: current concepts Can J Surg 1980;23:340.[Medline]
  35. Wilson JM, Thomas AN, Goodman PC, Lewis FR. Severe chest trauma: morbidity implication of first and second rib fracture in 120 patients Arch Surg 1978;113:846.[Medline]
  36. Hallen A, Hansson HE, Nordlund S. Thoracic injuries: a survey of 765 patients treated at the University Hospital, Uppsala, during the years 1956–1969 Scand J Thorac Cardiovasc Surg 1974;8:34.[Medline]
  37. Freed TA, Neal Jr MP, Vinik M. Roentgenographic findings in extracardiac injury secondary to blunt chest automobile trauma AJR 1968;104:424.[Abstract/Free Full Text]
  38. Flaherty TT, Wegner GP, Crummy AB, et al. Nonpenetrating injuries to the thoracic aorta Radiology 1969;92:541.[Abstract/Free Full Text]
  39. Davies ER, Roylance J. Aortography in the investigation of traumatic mediastinal haematoma Clin Radiol 1970;21:297.[Medline]
  40. Ovenfors C, Hedgcock MW. Intensive care unit radiology: problems of interpretation Radiol Clin North Am 1978;16:407.[Medline]
  41. Lipchik EO, Robinson KE. Acute traumatic rupture of the thoracic aorta AJR 1968;104:408.[Abstract/Free Full Text]
  42. Langbein IE, Brandt PWT. Traumatic rupture of the aorta Australas Radiol 1968;12:102.[Medline]
  43. Gerlock Jr AJ, Muhletaler CA, Coulam CM, Hayes PT. Traumatic aortic aneurysm: validity of esophageal tube displacement sign AJR 1980;135:713.[Abstract]
  44. Simeone JF, Minagi H, Putman CE. Traumatic disruption of the thoracic aorta: significance of the left apical extrapleural cap Radiology 1975;117:265.[Abstract/Free Full Text]
  45. Simeone JF, Deren MM, Cagle F. The value of the left apical cap in the diagnosis of aortic rupture: a prospective and retrospective study Radiology 1981;139:35.[Abstract/Free Full Text]
  46. Peters DR, Gamsu G. Displacement of the right paraspinous interface: a radiographic sign of acute traumatic rupture of the thoracic aorta Radiology 1980;134:599.[Abstract/Free Full Text]
  47. Tisnado J, Tsai FY, Als A, Roach JF. A new radiographic sign of acute traumatic rupture of the thoracic aorta: displacement of the nasogastric tube to the right Radiology 1977;125:603.[Abstract/Free Full Text]
  48. Brandt III B, Cram AE, Chow KC. Esophageal displacement secondary to blunt chest trauma Chest 1982;81:99.[Medline]
  49. Wales LR, Morishima MS, Reay D, Johansen K. Nasogastric tube displacement in acute traumatic rupture of the thoracic aorta: a postmortem study AJR 1982;138:821.[Abstract/Free Full Text]
  50. Gondos B. The left apical cap Radiology 1982;142:254.[Free Full Text]
  51. Gondos B. The roentgen image of the subclavian artery in the pulmonary apex AJR 1961;86:1058.
  52. Woodring JH, Pulmano CM, Stevens RK. The right paratracheal stripe in blunt chest trauma Radiology 1982;143:605.[Abstract/Free Full Text]
  53. Figley MM. Mediastinal minutiae Semin Roentgenol 1969;4:22.
  54. Savoca CJ, Austin JHM, Goldberg HI. The right paratracheal stripe Radiology 1977;122:295.[Abstract/Free Full Text]
  55. Stoney RJ, Roe BB, Redington JV. Rupture of thoracic aorta due to closed-chest trauma Arch Surg 1964;89:840.[Medline]
  56. Holmes Jr TW, Netterville RE. Complications of first rib fracture, including one case each of tracheoesophageal fistula and aortic arch aneurysm J Thorac Surg 1956;32:74.[Medline]
  57. Richardson JD, McElvein RB, Trinkle JK. First rib fracture: a hallmark of severe trauma Ann Surg 1975;181:251.[Medline]
  58. Fisher RG, Ward RE, Ben-Menachem Y, et al. Arteriography and the fractured first rib: too much for too little? AJR 1982;138:1059.[Abstract/Free Full Text]
  59. Woodring JH, Fried AM, Hatfield DR, et al. Fractures of first and second ribs: predictive value for arterial and bronchial injury AJR 1982;138:211.[Abstract/Free Full Text]
  60. Howell JF, Crawford ES, Jordan Jr GL. The flail chest: an analysis of 100 patients Am J Surg 1963;106:628.[Medline]
  61. Toombs BD, Sandler CM, Lester RG. Computed tomography of chest trauma Radiology 1981;140:733.[Abstract/Free Full Text]
  62. Toombs BD, Lester RG, Ben-Menachem Y, Sandler CM. Computed tomography in blunt trauma Radiol Clin North Am 1981;19:17.[Medline]
  63. Egan RJ, Neiman HL, Herman RJ, et al. Computed tomography in the diagnosis of aortic aneurysm dissection or traumatic injury Radiology 1980;136:141.[Abstract/Free Full Text]
  64. Baron RL, Levitt RF, Sagel SS, Stanley RJ. Computed tomography in the evaluation of mediastinal widening Radiology 1981;138:107.[Abstract/Free Full Text]



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This Article
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