A 45-year-old man involved in a high-speed frontal vehicle collision is haemodynamically stable with severe interscapular pain. Chest radiograph shows a widened superior mediastinum, blurring of the aortic knuckle, and depression of the left mainstem bronchus. After initial evaluation, the single best next investigation is:
- A Transoesophageal echocardiography
- B Digital subtraction angiography via femoral access
- C CT angiography of the thoracic aorta ✓
- D Serial chest radiographs every four hours
Correct answer: C. CT angiography of the thoracic aorta
Explanation
The described radiographic signs suggest traumatic aortic injury, typically at the isthmus just distal to the left subclavian artery where the mobile arch meets the fixed descending aorta. Contrast-enhanced CT angiography is now the diagnostic test of choice, being rapid, widely available, and highly sensitive for intimal tears and pseudoaneurysm. Catheter angiography, once the historical gold standard, is invasive and has been superseded, while serial films waste time in an injury that carries a high risk of free rupture.
Reference: ATLS Student Course Manual, American College of Surgeons, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.