A 25-year-old motorcyclist sustains a deceleration injury. Chest X-ray shows widened mediastinum (>8 cm), obliteration of the aortic knuckle, and left-sided haemothorax. What injury should be suspected and what is the definitive investigation?
- A Rib fractures — CT chest for count
- B Cardiac tamponade — echocardiography
- C Traumatic aortic injury — CT angiography of the aorta ✓
- D Diaphragmatic rupture — CXR with nasogastric tube
Correct answer: C. Traumatic aortic injury — CT angiography of the aorta
Explanation
Widened mediastinum (>8 cm at the aortic arch), obliterated aortic knuckle, deviation of left main bronchus downward, and left haemothorax after high-energy deceleration trauma are classic radiological signs of traumatic aortic injury (most commonly at the aortic isthmus, just distal to the left subclavian artery). CT angiography is the definitive investigation and has replaced aortography. Management is endovascular repair (TEVAR) or open surgery depending on the injury pattern.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
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