A 38-year-old man involved in a high-speed frontal collision has BP 100/70 mmHg and bilateral femur fractures. Supine chest X-ray shows a widened mediastinum, blurring of the aortic knob, and deviation of the nasogastric tube to the right. He is haemodynamically stable. What is the most appropriate next investigation?
- A Diagnostic peritoneal lavage
- B Transoesophageal echocardiography
- C CT angiography of the chest ✓
- D Arch aortography
Correct answer: C. CT angiography of the chest
Explanation
These radiographic signs suggest traumatic aortic injury, typically at the isthmus just distal to the left subclavian artery. In a stable patient, contrast-enhanced multidetector CT angiography is now the diagnostic test of choice with sensitivity above 95%. Conventional arch aortography, once the gold standard, has been replaced. Transoesophageal echo is used when the patient is too unstable for transport to CT. Peritoneal lavage does not assess the mediastinum.
Reference: Sabiston Textbook of Surgery, 21st ed.
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