A 32-year-old man involved in a high-speed road traffic accident is haemodynamically stable. Chest radiograph shows widening of the mediastinum, loss of the aortic knuckle contour, and deviation of the trachea to the right. The next most appropriate investigation to confirm the suspected diagnosis is:
- A CT angiography of the thoracic aorta ✓
- B Transoesophageal echocardiography as the first-line confirmatory test
- C Aortography via femoral arterial catheterisation
- D Serial chest radiographs over 24 hours
Correct answer: A. CT angiography of the thoracic aorta
Explanation
Widened mediastinum with an abnormal aortic contour after deceleration trauma suggests traumatic aortic injury, classically at the isthmus just distal to the left subclavian artery. CT angiography is the current first-line diagnostic test, being rapid and widely available in the emergency setting. Conventional aortography was the historical gold standard but has been replaced by CT angiography.
Reference: ATLS Advanced Trauma Life Support Student Course Manual, 10th ed.
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