A 35-year-old man involved in a high-speed frontal vehicle collision presents with chest and back pain. Chest radiograph shows a widened superior mediastinum, blurring of the aortic knuckle and deviation of the trachea to the right. He is haemodynamically stable. The single most appropriate investigation to confirm the suspected diagnosis is:

• A Transoesophageal echocardiography
• B Aortography via femoral artery catheterisation
• C Diagnostic peritoneal lavage
• D CT angiography of the chest ✓

Explanation

Widening of the mediastinum is the commonest radiographic sign of traumatic aortic injury following rapid deceleration, typically at the aortic isthmus just distal to the left subclavian artery. In a stable patient, contrast-enhanced CT angiography is now the diagnostic standard, being fast, widely available and highly accurate. Catheter aortography was the historical gold standard but is invasive and has been superseded. Transoesophageal echo is useful only when CT is unavailable or in unstable patients in theatre.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.