A 32-year-old man involved in a high-speed frontal collision is haemodynamically stable. Chest radiograph shows a widened mediastinum with blurring of the aortic knob and depression of the left main bronchus. There are no other significant injuries. The next best investigation is:
- A Transoesophageal echocardiography
- B CT angiography of the chest ✓
- C Aortic arch angiography
- D Serial chest radiographs every 6 hours
Correct answer: B. CT angiography of the chest
Explanation
The findings suggest traumatic aortic injury, typically at the isthmus just distal to the left subclavian artery. In a stable patient, contrast enhanced CT angiography is the diagnostic test of choice because it is rapid, widely available, and defines the anatomy for planning repair. Arch angiography was the former gold standard but has been replaced, and serial radiographs risk free rupture during the delay.
Reference: Schwartz's Principles of Surgery, 11th ed.
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