A 35-year-old man involved in a high speed frontal collision has chest pain, a weak right radial pulse, and blood pressure 150/90 in the right arm versus 120/70 in the left. Chest X-ray shows a widened mediastinum with blurring of the aortic knuckle. What is the most appropriate next investigation?

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

Explanation

The combination of deceleration injury, interarm blood pressure difference, and widened mediastinum points to traumatic aortic injury. Contrast enhanced CT angiography is the current first line investigation, being rapid, widely available, and accurate for defining the site and extent of the tear. Conventional aortography was the historical gold standard but is invasive and slower, while transoesophageal echo is reserved for unstable patients in whom CT cannot be performed.

Reference: Sabiston Textbook of Surgery, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.