A 35-year-old motorcyclist has blunt chest trauma. CXR shows widened mediastinum (>8 cm), loss of aortopulmonary window, rightward tracheal deviation, and a left-sided pleural cap. What is the most likely diagnosis?
- A Cardiac tamponade
- B Tension pneumothorax
- C Traumatic aortic injury at the aortic isthmus ✓
- D Diaphragmatic rupture
Correct answer: C. Traumatic aortic injury at the aortic isthmus
Explanation
The classic CXR signs of traumatic aortic injury include mediastinal widening (>8 cm or mediastinal-to-chest ratio >0.25), obliteration of the aortopulmonary window, tracheal shift to the right, left apical pleural cap (extrapleural hematoma), depression of left main bronchus, and nasogastric tube deviation. The aortic isthmus (just distal to the left subclavian artery origin) is the most vulnerable site due to differential deceleration forces. CT aortography is the confirmatory investigation of choice.
Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.
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Written and medically reviewed by the StethoPrep medical team.